Healthcare Provider Details

I. General information

NPI: 1285558114
Provider Name (Legal Business Name): KATIE JO RILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 FIELDSTONE RD STE A
CHAMPAIGN IL
61822-8808
US

IV. Provider business mailing address

4108 FIELDSTONE RD STE A
CHAMPAIGN IL
61822-8808
US

V. Phone/Fax

Practice location:
  • Phone: 217-260-3977
  • Fax:
Mailing address:
  • Phone: 217-260-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: