Active NPI
Kimberlee Marisa Manieri, BCBA
- Behavior Analyst
- Normal, IL
National Provider Identifier
1720563307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-23-65900
- Practice address
- 2000 Jacobssen Dr
Normal, IL 61761-6277 - Phone
- (309) 451-8888
- NPI assigned
- Sep 28, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-23-65900 | IL | Primary |
Addresses
Primary practice location
2000 Jacobssen Dr
Normal, IL 61761-6277
Mailing address
2000 Jacobssen Dr
Normal, IL 61761-6277
Phone (309) 451-8888
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifelong Access | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694044800000",
"number": "1720563307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 JACOBSSEN DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617616277",
"telephone_number": "309-451-8888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 JACOBSSEN DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617616277",
"telephone_number": "309-451-8888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANIERI",
"first_name": "KIMBERLEE",
"middle_name": "MARISA",
"credential": "BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-28",
"last_updated": "2023-09-07",
"certification_date": "2023-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "IL",
"license": "1-23-65900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.