Healthcare Provider Details

I. General information

NPI: 1710479662
Provider Name (Legal Business Name): KIMBERLY S WINKELMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 04/22/2022
Certification Date: 11/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 BORMET DR
MOKENA IL
60448-8303
US

IV. Provider business mailing address

9500 BORMET DR
MOKENA IL
60448-8303
US

V. Phone/Fax

Practice location:
  • Phone: 815-469-1500
  • Fax:
Mailing address:
  • Phone: 815-469-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-32898
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-47072
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: