Provider Demographics
NPI:1679161376
Name:KEPLER, IAN JAMES
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:JAMES
Last Name:KEPLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22868 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016-2504
Mailing Address - Country:US
Mailing Address - Phone:503-724-0637
Mailing Address - Fax:
Practice Address - Street 1:22868 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:CLATSKANIE
Practice Address - State:OR
Practice Address - Zip Code:97016-2504
Practice Address - Country:US
Practice Address - Phone:503-724-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health