Individual provider · Type 1 NPI

Kiley Jo Vanderport, BA

Mental Health Counselor · Mattoon, IL

NPI number 1174454672 Active

Practice location

750 Broadway Ave E
Mattoon, IL 61938-4610

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1174454672

Kiley Jo Vanderport, BA's National Provider Identifier is 1174454672, issued on May 26, 2026. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Mattoon, IL. The record was last updated on May 26, 2026.