Individual provider · Type 1 NPI
Ryan Kellog
Mental Health Counselor · East Peoria, IL
NPI number
1114556719
Active
Practice location
111 W Washington St Ste 203
East Peoria, IL 61611-2532
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | None listed |
Mental Health Counselor: Definition to come...
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About NPI 1114556719
Ryan Kellog's National Provider Identifier is 1114556719, issued on Apr 6, 2020. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in East Peoria, IL. The record was last updated on Sep 29, 2026.