Kelsey R Wedwick, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096004094 Issued in IL

Practice address

420 N Illinois Rte 31
Crystal Lake, IL 60012

Phone

(815) 656-5600

NPI assigned

Dec 9, 2022

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1670544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1154032274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 BUCKINGHAM DR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147666",
            "telephone_number": "815-601-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 N ILLINOIS RTE 31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60012",
            "telephone_number": "815-656-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDWICK",
        "first_name": "KELSEY",
        "middle_name": "R",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-09",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096004094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATHLETIC TRAINING BOARD OF CERTIFICATION",
            "identifier": "2000009754",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler Lee Watermann, DC
• Shannon Watley, DO
• Molly Marie Gruszeczka Webb, CCC-SLP/L
• Eliza Christine Weber
• Leslie Dawn Weckerlin, RPH
• Kristin Elise Weeks, LCSW
• Pamela Weeks, RN;LCSW
• Sharon Ann Weise, P.T.
• Everett Lawrence Weiss, M.D.
• David Welch, LCPC

• Athletic Trainer in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.