Provider Demographics
NPI:1003520800
Name:LEGAGNEUR, KELSEY E (QMHP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:E
Last Name:LEGAGNEUR
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-9314
Mailing Address - Country:US
Mailing Address - Phone:321-889-2360
Mailing Address - Fax:
Practice Address - Street 1:1790 NATIONS DR STE 110
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9175
Practice Address - Country:US
Practice Address - Phone:321-889-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health