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General NPI Number Information
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NPI Number | 1043017171
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Entity Type | Individual
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Provider Name | KELLY VILLANTI LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 308 POTOMAC AVE
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City | SAVOY
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State | IL
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Zip | 61874-8115
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Country | US
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Telephone | 847-452-3329
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Fax |
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Provider Business Mailing Address
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Address Line | 114 W HOUGHTON ST
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City | TUSCOLA
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State | IL
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Zip | 61953-1660
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Country | US
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Telephone | 217-253-4731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149026935
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License Number State | IL
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