Jack Kelly, BCBA
NPI 1396383030ActiveIndividual· Behavior Analyst· Lake Bluff, IL
Behavior Analyst (BCBA) in Lake Bluff, Illinois, licensed in IL, with an NPI issued in December 2019.
Overview
| NPI | 1396383030 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | BCBA |
| Sole proprietor | No |
| NPI issued | Dec 12, 2019 |
| Last updated in NPPES | Aug 12, 2021 |
| Certified by provider | Aug 12, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Behavior Analyst Primary | 103K00000X | 1-20-45283 | IL |
| Assistant Behavior Analyst | 106E00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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