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KELLY PRENDERGAST LPC
NPI 1669127536
Counselor - Professional in Chicago, IL

Active since February 18, 2022Opted out of Medicare · through Jan 1, 2028
3301 W 111TH ST, CHICAGO, IL 60655(312) 469-0486 Get Directions Write a Review

NPPES record last updated: February 18, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelly Prendergast Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY PRENDERGAST LPC (NPI 1669127536) is an individual professional provider in Chicago, Illinois, licensed in Illinois (178.017778) and active in the NPI registry since February 2022. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1669127536
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameKELLY PRENDERGASTCredential: LPC
Location Address3301 W 111TH STChicago, IL 60655-2715
Mailing Address3301 W 111th StChicago, IL 60655-2715 · (312) 469-0486
Phone(312) 469-0486
Sole ProprietorNo
Enumeration DateFebruary 18, 2022
NPPES CertifiedFebruary 18, 2022
✔ NPI 1669127536 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in IL · 178.017778
3301 W 111TH ST, Chicago, IL 60655
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Kelly Prendergast Lpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TANIA VELAZQUEZ
Social Worker (Clinical)
3301 W 111TH ST
CHICAGO, IL 60655
Cook County (312) 469-0486
ABBY GENTILE LCPC
Counselor (Mental Health)
3301 W 111TH ST
CHICAGO, IL 60655
Cook County (312) 469-0486
NATALIE DELEON LPC
Counselor (Professional)
3301 W 111TH ST
CHICAGO, IL 60655
Cook County (312) 469-0486
YADIRA TORO
Social Worker
3301 W 111TH ST
CHICAGO, IL 60655
Cook County (312) 278-7129
ANGELA BUSH
Counselor (Professional)
3301 W 111TH ST
CHICAGO, IL 60655
Cook County (312) 469-0486
DR. DONALD LYNN REED DC, L AC
Acupuncturist
3301 W 111TH ST
CHICAGO, IL 60655
Cook County (773) 881-0888
KAYLA TILKES
Counselor (Mental Health)
3301 W 111TH ST
CHICAGO, IL 60655
Cook County (312) 469-0486
BRENDAN TIMOTHY MURNEY
Counselor (Mental Health)
3301 W 111TH ST
CHICAGO, IL 60655
Cook County (312) 469-0486

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Prendergast's NPI number?

The NPI number for Kelly Prendergast is 1669127536. It was assigned to this individual provider in the NPPES registry on February 18, 2022.

Where is Kelly Prendergast located?

Kelly Prendergast practices at 3301 W 111th St, Chicago, IL 60655. The listed phone number is (312) 469-0486.

What is Kelly Prendergast's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Kelly Prendergast enrolled in Medicare?

No. Kelly Prendergast has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Kelly Prendergast was last updated on February 18, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.