Katie Neidetcher, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180011916 Issued in IL

Practice address

7210 N Villa Lake Dr Ste C
Peoria, IL 61614-8290

Phone

(309) 713-1485

Fax

(309) 419-4328

NPI assigned

Jun 26, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Full Circle Counseling and Wellness, LLC

  • Professional Counselor
  • Peoria, IL
  • NPI 1558976209
  Medicare reassignment NPD Authorized official
• Summit Family Therapy PLLC

  • Professional Counselor
  • Peoria, IL
  • NPI 1548704372
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1093376329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10286",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616120286",
            "telephone_number": "309-713-1485",
            "fax_number": "309-419-4328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7210 N VILLA LAKE DR STE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148290",
            "telephone_number": "309-713-1485",
            "fax_number": "309-419-4328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEIDETCHER",
        "first_name": "KATIE",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-26",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180011916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natural Balance Wellness Center
• Neck to Back Peoria LLC
• Allen Lynn Neese, M.D., PH.D.
• Angela Lynn Neese, PHD
• Addison Marie Neff, LPC
• Neighborhood House Association
• Ankita Chowdary Nekkanti, M.B.B.S.,
• Sai Aparna Nelakanti
• Aletha Latrice Nelms, APRN
• Nelson Chiropractic S C

• Professional Counselor in Peoria, IL
• Providers in Peoria, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.