Provider Demographics
NPI:1558172866
Name:DR. KELLY SANTOYO, PLLC
Entity type:Organization
Organization Name:DR. KELLY SANTOYO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOYO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-202-8380
Mailing Address - Street 1:1225 LONGFORD CIR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4829
Mailing Address - Country:US
Mailing Address - Phone:630-202-8380
Mailing Address - Fax:
Practice Address - Street 1:1225 LONGFORD CIR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4829
Practice Address - Country:US
Practice Address - Phone:630-202-8380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health