Jessica Lauren Blough, M.A., BCBA
Individual provider Active NPI Behavior Analyst · Mokena, IL
NPI 1649833112 · NPPES record last updated Apr 19, 2019
Key facts
- NPI
- 1649833112
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 11935455 (IL)
- Practice address
- 19056 Henry Dr
Mokena, IL 60448-9302 - Phone
- (708) 995-5751
- NPI assigned
- Apr 19, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11935455 | IL | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Behavior Intervention, Inc | Behavior Analyst | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 11935455 | IL | Yes |
Addresses
Primary practice location
19056 Henry Dr
Mokena, IL 60448-9302
Mailing address
9400 S Winchester Ave
Chicago, IL 60643-6350
Phone (773) 316-3099
Other providers in Mokena, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.