Ryan Kellog
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 203East Peoria, IL 61611-2532
Phone: (309) 671-8060
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Mental Health Counselor (primary) | Taxonomy 101YM0800X |
|---|
Record details
| NPI number | 1114556719 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | April 6, 2020 |
| Last updated in NPPES | April 6, 2020 |
| Certification date | April 6, 2020 |
| Mailing address | 111 W Washington St Ste 203, East Peoria, IL 61611-2532 |
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