Active NPI
Kelly Prendergast, LPC
- Professional Counselor
- Chicago, IL
National Provider Identifier
1669127536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.017778
- Practice address
- 3301 W 111TH St
Chicago, IL 60655-2715 - Phone
- (312) 469-0486
- NPI assigned
- Feb 18, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.017778 | IL | Primary |
Addresses
Primary practice location
3301 W 111TH St
Chicago, IL 60655-2715
Mailing address
3301 W 111TH St
Chicago, IL 60655-2715
Phone (312) 469-0486
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.017778 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645142400000",
"number": "1669127536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 W 111TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606552715",
"telephone_number": "312-469-0486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 W 111TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606552715",
"telephone_number": "312-469-0486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRENDERGAST",
"first_name": "KELLY",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-18",
"last_updated": "2022-02-18",
"certification_date": "2022-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.017778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.