Active NPI
Kaysie Domenico
- Behavior Technician
- Orland Park, IL
National Provider Identifier
1770454191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-25-453541
- Practice address
- 11309 Distinctive Dr
Orland Park, IL 60467-9490 - Phone
- (708) 738-4019
- NPI assigned
- Sep 17, 2025
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-25-453541 | IL | Primary |
Addresses
Primary practice location
11309 Distinctive Dr
Orland Park, IL 60467-9490
Mailing address
1018 Mountain View Dr
Joliet, IL 60432-0755
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-25-453541 | IL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758067200000",
"number": "1770454191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1018 MOUNTAIN VIEW DR",
"city": "JOLIET",
"state": "IL",
"postal_code": "604320755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11309 DISTINCTIVE DR",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604679490",
"telephone_number": "708-738-4019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMENICO",
"first_name": "KAYSIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-17",
"last_updated": "2025-09-17",
"certification_date": "2025-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": "RBT-25-453541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orland Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.