Healthcare Provider Details

I. General information

NPI: 1164377933
Provider Name (Legal Business Name): KELLI MAUREEN MCLAURIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E WILLOW AVE
WHEATON IL
60187-5426
US

IV. Provider business mailing address

222 E WILLOW AVE
WHEATON IL
60187-5426
US

V. Phone/Fax

Practice location:
  • Phone: 773-919-3299
  • Fax:
Mailing address:
  • Phone: 773-919-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150108800
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: