Healthcare Provider Details

I. General information

NPI: 1063201838
Provider Name (Legal Business Name): K & K WELLNESS LLC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 JOHNSON AVE NW STE 14
CEDAR RAPIDS IA
52405-4259
US

IV. Provider business mailing address

4990 JOHNSON AVE NW STE 14
CEDAR RAPIDS IA
52405-4259
US

V. Phone/Fax

Practice location:
  • Phone: 319-551-9973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0240116
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier1750926796
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: KATHRINE RACHEL BECKMAN-SHAULL
Title or Position: CEO
Credential: LISW
Phone: 319-551-9973