MRS. KELLY R. BRODERICK (NPI# 1881817443) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881817443 |
| Entity Type | Individual |
| Full Name | MRS. KELLY R. BRODERICK |
| Credential | L.P.C. |
| Practice Address |
515 S Ashland Ave La Grange IL 60525-2812 |
| Practice Telephone | 7083521880 |
| Practice Fax Number | 7083521880 |
| Mailing Telephone | 7083521880 |
| Mailing Fax Number | 7083521880 |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101Y00000X | Counselor | IL | Behavioral Health & Social Service Providers | |
| X | 222Q00000X | Developmental Therapist | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407193758 | Kelly Anne Broderick | Social Worker | 152 Lynnway Ste 2c, Lynn, MA 01902-3420 | 2013-01-07 |
| 1609821891 | Kelly Clark Broderick | Radiology | 100 S San Mateo Dr, San Mateo, CA 94401-3805 | 2006-05-24 |
| Street Address |
515 S ASHLAND AVE |
| City | LA GRANGE |
| State | IL |
| Zip Code | 60525-2812 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063923837 | Cheryl Buhrke | Speech-Language Pathologist | 1301 W. Cossitt Ave., La Grange, IL 60525 | 2017-10-19 |
| 1881113462 | Karen Aluise | Speech-Language Pathologist | 6818 Joliet Rd. #2, Indian Head Park, IL 60525 | 2017-09-14 |
| 1689126997 | Adriana Digianfilippo | Occupational Therapist | 18 N. Catherine, Lagrange, IL 60525 | 2016-11-03 |
| 1679953582 | Paulina Pinzon | Counselor | 6548 Laurel Avenue, Indian Head Park, IL 60525 | 2015-06-05 |
| 1639446925 | Aarti Parikh | Pharmacist | 6600 S. Willow Springs Rd, Indian Head Park, IL 60525 | 2011-11-30 |
| 1831476795 | Jessica E Feller | Physician Assistant | 6555 South Willow Springs Road, Suite 6, Countryside, IL 60525 | 2011-11-07 |
| 1477833218 | Robyn Lee Frendling | Behavioral Analyst | 9649 W. 55th St, Countryside, IL 60525 | 2011-08-25 |
| 1457630543 | Kerri E Kabela | Physical Therapist | 705 W. Plainfield Rd, Suite 1, Countryside, IL 60525 | 2011-08-08 |
| 1275826984 | G&u Orthopedic, LLC | Durable Medical Equipment & Medical Supplies | 106 W. Calendar Ave., 127, La Grange, IL 60525 | 2011-05-27 |
| 1952609752 | Athletic and Therapeutic Institute of Naperville, LLC | Physical Therapist | 705 W. Plainfield Road, Suite 1, Countryside, IL 60525 | 2011-03-03 |
| Find all providers in zip 60525 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861868218 | Denise Sandoval | Counselor | 21 S La Grange Rd Ste 200, La Grange, IL 60525-2479 | 2015-08-19 |
| 1982089587 | Fadia Damra | Counselor | 23 Calendar Ct Ste 201, La Grange, IL 60525-6327 | 2015-07-23 |
| 1750852737 | Christa Capalby | Counselor | 47 6th Ave Ste L, La Grange, IL 60525-5636 | 2018-12-17 |
| 1871007658 | Vrena Anton | Counselor | 23 Calendar Ct Ste 201, La Grange, IL 60525-6327 | 2017-11-30 |
| 1750733754 | Natalia Resendiz | Counselor | 23 Calendar Ct, Suite 207, La Grange, IL 60525-2365 | 2016-07-01 |
| 1609225861 | Mariana Luna | Counselor | 23 Calendar Ct Ste 201, La Grange, IL 60525-6327 | 2016-06-08 |
| 1033583158 | Felicia Meyers | Counselor | 2111 Spencer Ct, La Grange, KY 40031-6742 | 2015-12-01 |
| 1003109158 | Chelsea Northrip | Counselor | 2141 Spencer Ct, La Grange, KY 40031-6742 | 2011-05-24 |
| 1740595537 | Shannon Liebegott | Counselor | 2141 Spencer Ct, La Grange, KY 40031-6742 | 2010-08-17 |
| 1730310327 | Beverly Woosley | Counselor | 2141 Spencer Ct, La Grange, KY 40031-6742 | 2009-07-31 |
| Find all providers in LA GRANGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.