Individual provider Active NPI

Kellie Menter, PHD, LCP, NCSP

  • Clinical Neuropsychologist
  • Romeoville, IL
National Provider Identifier
1639054448
Registry record updated Sep 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
071-022304 Issued in IL
Practice address
1239 Windham Pkwy
Romeoville, IL 60446-1608
Phone
(815) 942-6323
Fax
(815) 941-0308
NPI assigned
Aug 11, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 071-022304 IL Primary

Addresses

Primary practice location

1239 Windham Pkwy
Romeoville, IL 60446-1608

Mailing address

PO Box 713260
Chicago, IL 60677-1260
Phone (630) 469-9200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmenter306745@dulyhealthandcare.direct-ci.com Direct

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
I20250930001734 IL Practitioner - Clinical Psychologist 3577069525 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1100 31St St
Suite 140
Downers Grove, IL 60515-5509

PO Box
Chicago, IL 60677

PO Box
Suite 713260
Chicago, IL 60677-1260

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071-022304ILMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dupage Medical Group LTD CurrentSince Sep 8, 2025 Accepting new patients
Dupage Medical Group LTD CurrentSince Sep 8, 2025 Accepting new patients

Locations

30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210

1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000

1239 Windham Pkwy
Romeoville, IL 60446

Interoperability endpoints

  • Direct secure messaging: kmenter306745@dulyhealthandcare.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1754870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757030400000",
    "number": "1639054448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771260",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 WINDHAM PKWY",
            "city": "ROMEOVILLE",
            "state": "IL",
            "postal_code": "604461608",
            "telephone_number": "815-942-6323",
            "fax_number": "815-941-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENTER",
        "first_name": "KELLIE",
        "credential": "PHD, LCP, NCSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-11",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071-022304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmenter306745@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1239 Windham Pkwy",
            "city": "Romeoville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604461608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Romeoville, IL

Sources for this page

Verify at the official NPI Registry.