KC Eating Disorder Clinic PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

KC EATING DISORDER CLINIC PLLC

Practice address

313 N Mattis Ave
Champaign, IL 61821-2460

Phone

(217) 377-0299

NPI assigned

Aug 28, 2025

Last updated

Aug 28, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kaitlyn Cornell, LCSW, CEDS-SNPI 1992290449

Title

Ceo

Phone

(217) 621-0766

Specialties & licenses 4

Addresses

Tax ID family

KC Eating Disorder Clinic PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• KC Eating Disorder Clinic PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Champaign, IL
  • NPI 1740169655
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kaitlyn Cornell, LCSW

  • Clinical Social Worker
  • Champaign, IL
  • NPI 1992290449
  NPD (past) Authorized official
• Daniel Thomas Foutch, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Champaign, IL
  • NPI 1669149134
  NPD (past)

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

{
    "created_epoch": "1756339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756339200000",
    "number": "1326927971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 FLORA DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618213212",
            "telephone_number": "217-621-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 N MATTIS AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618212460",
            "telephone_number": "217-377-0299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KC EATING DISORDER CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-28",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A",
        "authorized_official_last_name": "CORNELL",
        "authorized_official_first_name": "KAITLYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-621-0766",
        "authorized_official_credential": "LCSW, CEDS-S"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arjun Kaverimanian
• Erick Makio Kawakita, M.D.
• Susan Kazmierczak, MSW, LCSW
• KC Counseling, LLC
• KC Counseling, LLC (Kaitlyn Cornell)
• KC Eating Disorder Clinic PLLC
• Rhona Ke, MD
• Maura Christine Kealy, ATC
• April L Keaton, LCSW
• Joseph J Keeley, MD

• Clinic/Center in Champaign, IL
• Providers in Champaign, IL by specialty
• Clinic/Center in Illinois

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

Verify at the official NPI Registry.