Healthcare Provider Details

I. General information

NPI: 1992531693
Provider Name (Legal Business Name): KAITLYN OREAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4481 ASH GROVE DR STE B
SPRINGFIELD IL
62711-6359
US

IV. Provider business mailing address

4481 ASH GROVE DR STE B
SPRINGFIELD IL
62711-6359
US

V. Phone/Fax

Practice location:
  • Phone: 217-247-4421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.021820
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.021820
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: