Active NPI
Kerry Bouck
- Developmental Therapist
- Mokena, IL
National Provider Identifier
1568612489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 11820 Wembley Dr
Mokena, IL 60448-2420 - Phone
- (708) 243-0009
- Fax
- (708) 479-1352
- NPI assigned
- Sep 28, 2008
- Last updated
- Sep 28, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | IL | Primary |
Addresses
Primary practice location
11820 Wembley Dr
Mokena, IL 60448-2420
Mailing address
11820 Wembley Dr
Mokena, IL 60448-2420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222560000000",
"number": "1568612489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11820 WEMBLEY DR",
"city": "MOKENA",
"state": "IL",
"postal_code": "604482420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11820 WEMBLEY DR",
"city": "MOKENA",
"state": "IL",
"postal_code": "604482420",
"telephone_number": "708-243-0009",
"fax_number": "708-479-1352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCK",
"first_name": "KERRY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-28",
"last_updated": "2008-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mokena, IL
- Jessica Lauren Blough, M.A., BCBA
- Body in Sync Physical Therapy, LTD. (Body in Sync Physical Therapy)
- Bone & Joint Surgeons, LTD
- Samantha Bonzani, FNP-BC
- Katie Boothe
- Kathryn Boudouris, MS, OTR/L
- Tara Boyles
- Braden Partners LP (Pacific Pulmonary Services)
- Rachel Michelle Brauer Dever, NP-C
- Nicole D Bray, OTRL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.