Jacqueline Kelly-Faddler, MS, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

842 Issued in MN

Practice address

501 4TH St S Ste 201
Princeton, MN 55371-4754

Phone

(763) 498-1822

NPI assigned

Sep 25, 2013

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

Other identifiers 1

Other names 1

• Jacqueline Faddler Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Mental Health Counselor

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

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.

• Trilogy Counseling Services PLLC

  dba Trilogy Counseling

  • Professional Counselor
  • Princeton, MN
  • NPI 1497246433
  Medicare reassignment NPD Authorized official
• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MN, Professional

  Medicare reassignment NPD

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

{
    "created_epoch": "1380067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1881020527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 4TH ST S STE 201",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553714754",
            "telephone_number": "763-482-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 4TH ST S STE 201",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553714754",
            "telephone_number": "763-498-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY-FADDLER",
        "first_name": "JACQUELINE",
        "credential": "MS, LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-25",
        "last_updated": "2022-05-02",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881020527",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://trilogycounselingmn.com/contact/",
            "affiliation": "N",
            "address_1": "501 4th St S Ste 201",
            "city": "Princeton",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553714754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FADDLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Glenn Orville Kallevig, O.D.
• Brianna Elaine Kastner
• Jacob David Kastner, D.O.
• James T Katter, MD
• Joseph Kelley
• Bobbi Kelton
• Tyler Kemnitz, PT
• Sara Suzanne Kemp
• Nicole Irene Kenyon, P.T.
• Ann Marie Killingsworth, OTR/L

• Professional Counselor in Princeton, MN
• Providers in Princeton, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.