Healthcare Provider Details

I. General information

NPI: 1093640252
Provider Name (Legal Business Name): KELLY SCOTT VIEL LPC, PEL-SC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7124 WINDSOR LAKE PKWY STE 10
LOVES PARK IL
61111-3802
US

IV. Provider business mailing address

906 OAKMONT PL
ROCKFORD IL
61107-3734
US

V. Phone/Fax

Practice location:
  • Phone: 815-601-4273
  • Fax:
Mailing address:
  • Phone: 815-601-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.018084
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: