Taylor Wallis, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

150116163 Issued in IL

Practice address

2125 S Neil St
Champaign, IL 61820-7266

Phone

(217) 352-0200

Fax

(217) 607-1139

NPI assigned

Jan 29, 2025

Last updated

Jun 11, 2025By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Keri Powell Therapy Inc

  dba Keri Powell Therapy

  • Mental Health Counselor
  • Champaign, IL
  • NPI 1174751663
  NPD

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

{
    "created_epoch": "1738108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749600000000",
    "number": "1427861988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 S NEIL ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207266",
            "telephone_number": "217-352-0200",
            "fax_number": "217-607-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 S NEIL ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207266",
            "telephone_number": "217-352-0200",
            "fax_number": "217-607-1139"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "208 S Market St",
            "address_purpose": "LOCATION",
            "city": "Monticello",
            "state": "IL",
            "postal_code": "618561835",
            "country_code": "US",
            "telephone_number": "217-352-0200",
            "fax_number": "217-607-1139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "TAYLOR",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-29",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150116163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kanisha Wallace
• Douglas M Wallen
• Shawna Marie Waller, LCPC
• Taylor Waller
• Carol Lynn Gates Walling, M.ED, , COMS
• Walmart Inc.
• Marie Neel Walser
• Deborah Lynn Walsh, APN
• Harlie Renee Walters
• Corelle Walton

• Social Worker in Champaign, IL
• Providers in Champaign, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.