Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ryan Kellog

Individual provider Mental Health Counselor · NPI 1114556719

Ryan Kellog is a Mental Health Counselor in East Peoria, Illinois. Registered with an NPI since 2020.

In the registry since
2020

Practice location Address checks out

111 W Washington St Ste 203
East Peoria, IL 61611-2532
Phone: (309) 671-8060
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1114556719
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 6, 2020
Last updated in NPPESApril 6, 2020
Certification dateApril 6, 2020
Mailing address111 W Washington St Ste 203, East Peoria, IL 61611-2532

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