Provider Demographics
NPI:1235627829
Name:CORTESE, KARA ANN (RBT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ANN
Last Name:CORTESE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CITADEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-3805
Mailing Address - Country:US
Mailing Address - Phone:815-985-8175
Mailing Address - Fax:
Practice Address - Street 1:3201 CITADEL DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-3805
Practice Address - Country:US
Practice Address - Phone:815-985-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-54148106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician