Healthcare Provider Details

I. General information

NPI: 1902701287
Provider Name (Legal Business Name): MAKENNA INGLE LPC,MS,NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENNETH ELLIOTT INGLE LPC,MS,NCC

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 WINDSOR PL STE A
CHAMPAIGN IL
61820-7773
US

IV. Provider business mailing address

1203 WESLEY AVE APT 210
SAVOY IL
61874-9302
US

V. Phone/Fax

Practice location:
  • Phone: 217-552-1058
  • Fax:
Mailing address:
  • Phone: 217-413-8059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.032944
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: