Individual
KELLY ANN PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
659 RIDGEVIEW DR, MCHENRY, IL 60050-7012
(815) 344-1999
Mailing address
755 MCARDLE DR STE C, CRYSTAL LAKE, IL 60014-1717
(815) 338-6600
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20042375A
IN
103TC0700X
Clinical Psychologist
071007917
IL
103TC0700X
Clinical Psychologist
Primary
117693
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071007917
STATE LICENSE
IL
Enumeration date
04/17/2008
Last updated
05/29/2023
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