Kelly Jean Wydra, L.C.P.C., C.A.D.C.

Primary specialty

CounselorTaxonomy code 101Y00000X

License

180.007933 Issued in IL

Practice address

4923 Main St
Downers Grove, IL 60515-3654

Phone

(815) 651-1983

NPI assigned

Dec 5, 2016

Last updated

Dec 5, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Alder Grove Counseling, LTD.

  • Community/Behavioral Health Agency
  • Downers Grove, IL
  • NPI 1942610738
  NPD (past)

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

{
    "created_epoch": "1480896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1447794763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1223 RHODES LN",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605400341",
            "telephone_number": "815-651-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4923 MAIN ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605153654",
            "telephone_number": "815-651-1983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYDRA",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "L.C.P.C., C.A.D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-05",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "180.007933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariah Wright, CD ( DONA)
• Parres Mone Wright, O.D.
• Allison Wrolson, PHD
• WSKC Dialysis Services, Inc. (Downers Grove Dialysis Center)
• Luke Alexander Wychocki
• Christine Wyka, APN
• William H. Wyssman, O.D.
• Ke Xu, D.M.D.
• Tania M Yackle, LCSW
• Patricia Yadgir, LCPC

• Counselor in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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.