Kelly, Jack

Kelly, Jack is an individual health care provider with primary practice located at 917 Sherwood Dr Ste 201 , Lake Bluff IL 60044-2235. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Assistant Behavior Analyst, Behavioral Health & Social Service Providers / Behavioral Analyst. Behavioral Health & Social Service Providers / Behavioral Analyst is his primary health care specialty. Kelly, Jack can be contacted via phone (877) 486-4140.

Contact Information

Primary practice address
917 Sherwood Dr Ste 201 Lake Bluff IL 60044-2235
Phone: (877) 486-4140
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Assistant Behavior Analyst 106E00000X
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-20-45283 Illinois

Profile Details

NPI number 1396383030
LBN Legal business name Kelly, Jack
Credentials BCBA
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 12th, 2019
Last updated Aug 12th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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