Healthcare Provider Details

I. General information

NPI: 1316420813
Provider Name (Legal Business Name): JANICE KERR LCPC, PEL-SC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 06/13/2022
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 S ROUTE 30 STE 204B
PLAINFIELD IL
60544-5688
US

IV. Provider business mailing address

26914 SUMMERGROVE DR
PLAINFIELD IL
60585-2922
US

V. Phone/Fax

Practice location:
  • Phone: 630-597-6779
  • Fax: 630-806-8078
Mailing address:
  • Phone: 571-261-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180013129
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: