Individual provider Active NPI

Kristen M Kellerhals, BA

  • Clinical Social Worker
  • Champaign, IL
National Provider Identifier
1457979676
Registry record updated May 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
2506 Galen Dr Ste 108
Champaign, IL 61821-7047
Phone
(217) 238-5700
Fax
(217) 238-5767
NPI assigned
Jul 14, 2020
Last updated
May 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

2506 Galen Dr Ste 108
Champaign, IL 61821-7047

Mailing address

2506 Galen Dr Ste 108
Champaign, IL 61821-7047

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230317000770 IL Practitioner - Clinical Social Worker 3375917164 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3362 Big Pine Trail
Suite a
Champaign, IL 61822

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Rosecrance Inc Current Accepting new patients
Rosecrance CurrentSince Oct 13, 2025 Accepting new patients
Rosecrance Inc CurrentSince Oct 13, 2025 Accepting new patients
Dulski Counseling, LLC Mental Health CurrentSince Sep 21, 2025 Accepting new patients

Locations

3362 Big Pine Trl
Ste A
Champaign, IL 61822
Phone (217) 383-0151

1021 N Mulford Rd
Rockford, IL 61107
Phone (815) 387-5600

1601 University Dr
Rockford, IL 61107
Phone (815) 387-2500

Organizations & group practices 4

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": "1594684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779926400000",
    "number": "1457979676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 GALEN DR STE 108",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618217047",
            "fax_number": "217-238-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2506 GALEN DR STE 108",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618217047",
            "telephone_number": "217-238-5700",
            "fax_number": "217-238-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLERHALS",
        "first_name": "KRISTEN",
        "middle_name": "M",
        "credential": "BA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-14",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.