Provider Demographics
NPI:1235756347
Name:PAPA, KENDALL (MA BCBA)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:PAPA
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6407
Mailing Address - Country:US
Mailing Address - Phone:224-538-0595
Mailing Address - Fax:
Practice Address - Street 1:2601 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6407
Practice Address - Country:US
Practice Address - Phone:224-538-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-43029103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-43029OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD