Active NPI
Kristen Fanella
- Professional Counselor
- Machesney Park, IL
National Provider Identifier
1255114294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 1205 W Lane Rd
Machesney Park, IL 61115-1625 - Phone
- (815) 655-7989
- NPI assigned
- Aug 15, 2023
- Last updated
- Apr 28, 2025
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | Primary |
Addresses
Primary practice location
1205 W Lane Rd
Machesney Park, IL 61115-1625
Mailing address
1205 W Lane Rd
Machesney Park, IL 61115-1625
Other practice location 1
5906 Elaine Dr
Rockford, IL 61108-2467
Phone (779) 210-3453
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willow Creek Counseling LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745798400000",
"number": "1255114294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1205 W LANE RD",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611151625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1205 W LANE RD",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611151625",
"telephone_number": "815-655-7989"
}
],
"practiceLocations": [
{
"address_1": "5906 Elaine Dr",
"address_purpose": "LOCATION",
"city": "Rockford",
"state": "IL",
"postal_code": "611082467",
"country_code": "US",
"telephone_number": "779-210-3453",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FANELLA",
"first_name": "KRISTEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-15",
"last_updated": "2025-04-28",
"certification_date": "2025-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Machesney Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.