Ryan Kellog
NPI #1114556719 in East Peoria, Illinois
Provider Information
- NPI Number
- 1114556719
- Entity Type
- Individual
- Name
- Ryan Kellog
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Counselor - Mental Health
- Enumeration Date
- Apr 6, 2020
- Last Updated
- Apr 6, 2020
Practice Location
- Address
- 111 W WASHINGTON ST STE 203
- City
- East Peoria
- State
- Illinois
- ZIP Code
- 61611-2532
- Phone
- (309) 671-8060
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Mental Health — Mental Health |
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