Provider Demographics
NPI:1992192009
Name:SHONTZ, KENNEDY (BCBA)
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:SHONTZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 BENEDETTI DR
Mailing Address - Street 2:APT 101
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8932
Mailing Address - Country:US
Mailing Address - Phone:815-263-5918
Mailing Address - Fax:
Practice Address - Street 1:1260 IROQUOIS AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1689
Practice Address - Country:US
Practice Address - Phone:630-210-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-15-18350103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst