Healthcare Provider Details

I. General information

NPI: 1225957046
Provider Name (Legal Business Name): KELLY KNAPIK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 MILLENNIUM DR
CRYSTAL LAKE IL
60012-3747
US

IV. Provider business mailing address

3004 E CHESTNUT DR
WONDER LAKE IL
60097-9399
US

V. Phone/Fax

Practice location:
  • Phone: 815-477-4720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.129665
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: