# KC EATING DISORDER CLINIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326927971
- **Authorized official:** KAITLYN CORNELL LCSW, CEDS-S (CEO)
- **Authorized official phone:** (217) 621-0766

## Contact information

- **Practice address:** 313 N MATTIS AVE, CHAMPAIGN, IL 61821-2460
- **Practice address phone:** (217) 377-0299
- **Mailing address:** 203 FLORA DR, CHAMPAIGN, IL 61821-3212
- **Mailing address phone:** (217) 621-0766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/28/2025
- **Last updated:** 08/28/2025