MEDICARE: KELLY MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1639030257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARTIN

Provider Business Mailing Address
First Line	:	54 N OTTAWA ST STE 245
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60432-4378
Country	:	US
Telephone Number	:	833-777-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 N OTTAWA ST STE 245
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60432-4378
Country	:	US
Telephone Number	:	833-777-6352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2025
Last Update Date	:	11/21/2025

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Directions to “ KELLY MARTIN ” Practice Location

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