Active NPI
Katherine Anne Formentini
- Professional Counselor
- New Lenox, IL
National Provider Identifier
1861048993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.015057
- Practice address
- 1414 Eagle Vista Dr
New Lenox, IL 60451-2315 - Phone
- (815) 931-2060
- NPI assigned
- Aug 14, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 178.015057 | IL | Primary |
Addresses
Primary practice location
1414 Eagle Vista Dr
New Lenox, IL 60451-2315
Mailing address
1414 Eagle Vista Dr
New Lenox, IL 60451-2315
Phone (815) 931-2060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.015057 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565740800000",
"number": "1861048993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 EAGLE VISTA DR",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604512315",
"telephone_number": "815-931-2060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 EAGLE VISTA DR",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604512315",
"telephone_number": "815-931-2060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMENTINI",
"first_name": "KATHERINE",
"middle_name": "ANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-14",
"last_updated": "2019-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.015057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Lenox, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.