Individual
KELSEY R WEDWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
420 N ILLINOIS RTE 31, CRYSTAL LAKE, IL 60012
(815) 656-5600
Mailing address
400 BUCKINGHAM DR, CRYSTAL LAKE, IL 60014-7666
(815) 601-3816
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096004094
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000009754
ATHLETIC TRAINING BOARD OF CERTIFICATION
—
Enumeration date
12/09/2022
Last updated
12/09/2022
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