Provider Demographics
NPI:1972003358
Name:MANKE, CARA ELISE (BCBA)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ELISE
Last Name:MANKE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 PINTAIL DR STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6738
Mailing Address - Country:US
Mailing Address - Phone:502-297-0133
Mailing Address - Fax:
Practice Address - Street 1:3921 PINTAIL DR STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6738
Practice Address - Country:US
Practice Address - Phone:502-297-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-16-26842106S00000X
1-23-69866103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician