Active NPI
Katelyn Marie Wood, MS LPC
- Professional Counselor
- Champaign, IL
National Provider Identifier
1952736381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.007778
- Practice address
- 1801 Fox Dr
Champaign, IL 61820-7236 - Phone
- (217) 693-4572
- Fax
- (217) 398-0172
- NPI assigned
- Sep 4, 2013
- 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 | 178.007778 | IL | Primary |
Addresses
Primary practice location
1801 Fox Dr
Champaign, IL 61820-7236
Mailing address
1801 Fox Dr
Champaign, IL 61820-7236
Phone (217) 693-4572
Other names 1
- Katelyn Misdom
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.007778 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378252800000",
"number": "1952736381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 FOX DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618207236",
"telephone_number": "217-693-4572",
"fax_number": "217-398-0172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 FOX DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618207236",
"telephone_number": "217-693-4572",
"fax_number": "217-398-0172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "KATELYN",
"middle_name": "MARIE",
"credential": "MS LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-04",
"last_updated": "2013-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.007778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KATELYN",
"last_name": "MISDOM",
"credential": "MS LPC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.