Healthcare Provider Details

I. General information

NPI: 1558172866
Provider Name (Legal Business Name): DR. KELLY SANTOYO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 LONGFORD CIR
ELGIN IL
60120-4829
US

IV. Provider business mailing address

1225 LONGFORD CIR
ELGIN IL
60120-4829
US

V. Phone/Fax

Practice location:
  • Phone: 224-236-2336
  • Fax:
Mailing address:
  • Phone: 224-236-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLY SANTOYO
Title or Position: OWNER
Credential: PSYD
Phone: 224-236-2336