Healthcare Provider Details

I. General information

NPI: 1497840029
Provider Name (Legal Business Name): JOANNA KLING M.ED., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 FOX DR STE S
CHAMPAIGN IL
61820-7364
US

IV. Provider business mailing address

2009 FOX DR STE S
CHAMPAIGN IL
61820-7364
US

V. Phone/Fax

Practice location:
  • Phone: 217-621-5234
  • Fax:
Mailing address:
  • Phone: 217-621-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180002010
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: