Individual
KELLSIE EDGCOMB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
552 E US HIGHWAY 52, UTICA, IL 61373-9766
(815) 915-9460
Mailing address
552 E US HIGHWAY 52, UTICA, IL 61373-9766
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
225X00000X
Occupational Therapist
Primary
056016950
IL
Other
Enumeration date
08/04/2021
Last updated
02/24/2026
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