Individual provider Active NPI

Kymberly Jay Wiedenkeller, MA, MFT

  • Marriage & Family Therapist
  • Elgin, IL
National Provider Identifier
1225975253
Registry record updated Apr 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
208001353 Issued in IL
Practice address
244 S Randall Rd # 808
Elgin, IL 60123-5529
Phone
(847) 595-0662
NPI assigned
Apr 29, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 208001353 IL Primary

Addresses

Primary practice location

244 S Randall Rd # 808
Elgin, IL 60123-5529

Mailing address

209 Kelsey Rd
Lake Barrington, IL 60010-1557
Phone (310) 429-1974

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
208001353ILMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1777420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777420800000",
    "number": "1225975253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 KELSEY RD",
            "city": "LAKE BARRINGTON",
            "state": "IL",
            "postal_code": "600101557",
            "telephone_number": "310-429-1974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 S RANDALL RD # 808",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601235529",
            "telephone_number": "847-595-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDENKELLER",
        "first_name": "KYMBERLY",
        "middle_name": "JAY",
        "credential": "MA, MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-29",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "208001353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 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.

Verify at the official NPI Registry.