Active NPI
Ryan Kellog
- Mental Health Counselor
- East Peoria, IL
National Provider Identifier
1114556719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 111 W Washington St Ste 203
East Peoria, IL 61611-2532 - Phone
- (309) 671-8060
- NPI assigned
- Apr 6, 2020
- Last updated
- Sep 29, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NU | Primary |
Addresses
Primary practice location
111 W Washington St Ste 203
East Peoria, IL 61611-2532
Mailing address
111 W Washington St Ste 203
East Peoria, IL 61611-2532
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | rkellog@hscpeoria.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790640000000",
"number": "1114556719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 W WASHINGTON ST STE 203",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616112532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 W WASHINGTON ST STE 203",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616112532",
"telephone_number": "309-671-8060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLOG",
"first_name": "RYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-06",
"last_updated": "2026-09-29",
"certification_date": "2020-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "rkellog@hscpeoria.org",
"affiliation": "N",
"address_1": "111 W Washington St Ste 203",
"city": "East Peoria",
"state": "IL",
"country_code": "US",
"postal_code": "616112532",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in East Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.