Provider Demographics
NPI:1053993428
Name:HARPER, KEVIN DUANE (LSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DUANE
Last Name:HARPER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 COBBLESTONE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-4619
Mailing Address - Country:US
Mailing Address - Phone:317-370-0697
Mailing Address - Fax:
Practice Address - Street 1:448 COBBLESTONE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-4619
Practice Address - Country:US
Practice Address - Phone:317-370-0697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
INKIUGIYFVLUYFOUTDKIYUMedicaid