Healthcare Provider Details

I. General information

NPI: 1053274878
Provider Name (Legal Business Name): KENNADY PEARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE STE L500
NORMAL IL
61761-3551
US

IV. Provider business mailing address

1306 FITZER DR
JOLIET IL
60431-5377
US

V. Phone/Fax

Practice location:
  • Phone: 309-451-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-480698
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: