Active NPI
Kerry Dueholm, LPC
- Professional Counselor
- Barrington, IL
National Provider Identifier
1124482302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.011768
- Practice address
- 1000 Hart Rd
Suite 201
Barrington, IL 60010-2659 - Phone
- (847) 382-4683
- NPI assigned
- Apr 13, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.011768 | IL | Primary |
Addresses
Primary practice location
1000 Hart Rd
Suite 201
Barrington, IL 60010-2659
Mailing address
25285 W Ivanhoe Rd
Wauconda, IL 60084-2405
Phone (773) 301-6428
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 14, 2024 through Jun 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.011768 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460505600000",
"number": "1124482302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25285 W IVANHOE RD",
"city": "WAUCONDA",
"state": "IL",
"postal_code": "600842405",
"telephone_number": "773-301-6428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 HART RD",
"address_2": "SUITE 201",
"city": "BARRINGTON",
"state": "IL",
"postal_code": "600102659",
"telephone_number": "847-382-4683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUEHOLM",
"first_name": "KERRY",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-13",
"last_updated": "2016-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.011768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Barrington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.