Individual ProviderKaitlyn TalleyCounselorBehavioral Health & Social Service ProvidersPractice Address100 N Main St Ste 12, Edwardsville, IL 62025-1981(618) 513-9744PECOS EnrollmentBased on the most recent information from CMS, provider Kaitlyn Talley does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1245960343Provider TypeIndividualFull NameTalley, KaitlynGenderFemaleSole ProprietorYesEnumeration Date6/13/2022Last Updated8/26/2024Contact InformationPractice LocationPractice Address100 N Main St Ste 12, Edwardsville, IL 62025-1981Phone(618) 513-9744FaxUnlisted FaxMailing LocationMailing Address308 M St, Edwardsville, IL 62025-1024PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense180.016326IllinoisCode101YP2500XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer