Active NPI
Ivy Amelia Domont
- Behavior Analyst
- Northbrook, IL
National Provider Identifier
1912366345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-15-17998
- Practice address
- 85 Revere Dr Ste Aa
Northbrook, IL 60062-8001 - Phone
- (847) 564-0822
- NPI assigned
- Feb 12, 2016
- 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 | 1-15-17998 | PA | Primary |
Addresses
Primary practice location
85 Revere Dr Ste Aa
Northbrook, IL 60062-8001
Mailing address
85 Revere Dr Ste Aa
Northbrook, IL 60062-8001
Phone (847) 564-0822
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": "1455235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455235200000",
"number": "1912366345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 REVERE DR STE AA",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600628001",
"telephone_number": "847-564-0822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 REVERE DR STE AA",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600628001",
"telephone_number": "847-564-0822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMONT",
"first_name": "IVY",
"middle_name": "AMELIA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-12",
"last_updated": "2016-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "PA",
"license": "1-15-17998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.