KELLY ANN PETTIT (PSYD) – Clinical Psychologist, NPI 1194999409

KELLY ANN PETTIT (PSYD) is a healthcare provider. based in Woodstock, Illinois. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PSYD. They hold a License No. 20042375A (IN). The NPI Number for KELLY ANN PETTIT (PSYD) is 1194999409

Main info

Female
18 Years Of Experience
Accepts Medicare Assignment
Name
KELLY ANN PETTIT (PSYD)
NPI
1194999409
Phone
(815) 338-6600
Address
3701 Doty Rd
Enumeration Date
17 April 2008
Last Update Date
29 May 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8153441999
Graduation Year
2008 (18 years ago)
PAC ID
5890988984
Group Practice PAC ID
1658524475
Professional Enrollment ID
I20101021000562
Address ID
IL600507012MC659XXDRXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience83
Completeness75
Years active:18State licenses:3Digital endpointsOther names

1,600 CLINICAL PSYCHOLOGIST in IL

Provider Addresses for KELLY ANN PETTIT (PSYD)

  • 3701 Doty Rd

    Woodstock, IL 600987509

    Phone: (815) 338-6600

    Fax: (815) 206-5376

    Type: Location

  • 4201 W Medical Center Dr

    McHenry, IL 600508409

    Phone: (815) 338-6600

    Fax: (815) 206-5376

    Type: Location

  • 10400 Haligus Rd

    Huntley, IL 601429553

    Phone: (815) 338-6600

    Fax: (815) 206-5376

    Type: Location

  • 750 E Terra Cotta Ave Ste A

    Crystal Lake, IL 600143621

    Phone: (815) 344-1999

    Fax: (815) 516-5171

    Type: Location

  • 755 MCARDLE DR STE C

    CRYSTAL LAKE, IL 600141717

    Phone: (815) 338-6600

    Type: Mailing

  • Ridgeview Drive, McHenry County, Illinois, 60142, United States

    MCHENRY, IL 600507012

    Phone: (815) 344-1999

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-05-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20101021000562IClinical PsychologistILTBD
I20230530002362IClinical PsychologistIATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
90834Psychotherapy, 45 minutes49287$0
90832Psychotherapy, 30 minutes227112$0
90791Psychiatric diagnostic evaluation135134$0
View full utilization report →

Insurance plans in this area (ZIP 60098)

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Provider's Procedures

KELLY ANN PETTIT (PSYD) performs procedures in CLINICAL PSYCHOLOGIST. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHOLOGIST, CLINICALIL96118Neuropsychological testing, interpretation, and report by psychologist or physician per hour8625

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1658524475View full group profile
NameSpecialtyState
Clinical PsychologistIL
Clinical PsychologistTX
Clinical Social WorkerIL

Reviews

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Frequently asked questions

Does KELLY ANN PETTIT (PSYD) have a public NPI I can cite?
Public records show KELLY ANN PETTIT (PSYD) under NPI 1194999409.
Does the public listing show KELLY ANN PETTIT (PSYD) as active?
KELLY ANN PETTIT (PSYD)'s NPI record reflects an active status in NPPES.
What does the directory say KELLY ANN PETTIT (PSYD) does?
Insurance directories may phrase it differently, but here KELLY ANN PETTIT (PSYD) maps to Clinical Psychologist. Clinical services aligned with this taxonomy classification.
What city is tied to KELLY ANN PETTIT (PSYD)?
The directory associates KELLY ANN PETTIT (PSYD) with Woodstock, Illinois. Check all listed addresses for suites or satellite offices.
Can I export KELLY ANN PETTIT (PSYD)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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