Kelli D Canada, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149019506 Issued in IL

Practice address

911 Remington Rd Ste B
Mattoon, IL 61938-4210

Phone

(217) 234-3091

Fax

(217) 543-2548

NPI assigned

Aug 7, 2017

Last updated

Jul 21, 2022By the provider in NPPES

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: kelli.canada.1@9559.direct.athenahealth.com

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

{
    "created_epoch": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1336664705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 REMINGTON RD STE B",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384210",
            "telephone_number": "217-234-3091",
            "fax_number": "217-543-2548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 REMINGTON RD STE B",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384210",
            "telephone_number": "217-234-3091",
            "fax_number": "217-543-2548"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Broadway Ave E Ste 39",
            "address_purpose": "LOCATION",
            "city": "Mattoon",
            "state": "IL",
            "postal_code": "619384662",
            "country_code": "US",
            "telephone_number": "217-234-3091",
            "fax_number": "217-543-2548",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "525 N Vine St",
            "address_purpose": "LOCATION",
            "city": "Arthur",
            "state": "IL",
            "postal_code": "619111130",
            "country_code": "US",
            "telephone_number": "217-543-2446",
            "fax_number": "217-543-2548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANADA",
        "first_name": "KELLI",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-07",
        "last_updated": "2022-07-21",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149019506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelli.canada.1@9559.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "700 Broadway Ave E Ste 39",
            "city": "Mattoon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "619384662",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelli.canada.1@9559.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "911 Remington Rd Ste B",
            "city": "Mattoon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "619384210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrew Gene Caldieraro, DMD
• John Caltry, D.O.
• Domenica Camaci-Douleh
• Timothy H Camden, MD
• Quinn Easton Camfield, PA-C, RRT
• Channing Caraway, MS, CCC-SLP
• Carle Foundation Hospital (Carle RX Express)
• Carle Health Care Incorporated (Carle Physician Group)
• Carle Health Care Incorporated (Carle Physician Group)
• Carle Health Medical Group (Carle Physician Group)

• Clinical Social Worker in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.