Healthcare Provider Details

I. General information

NPI: 1518600592
Provider Name (Legal Business Name): KELLY RENNELS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 TUXEDO LN
CARY IL
60013-1714
US

IV. Provider business mailing address

308 TUXEDO LN
CARY IL
60013-1714
US

V. Phone/Fax

Practice location:
  • Phone: 847-721-0172
  • Fax:
Mailing address:
  • Phone: 847-721-0172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149041116
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150107416
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: