Provider Demographics
NPI:1679885115
Name:KEPPEN, HEATHER R ((LCPC) PHD, MED)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:R
Last Name:KEPPEN
Suffix:
Gender:F
Credentials:(LCPC) PHD, MED
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:BONNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:3923 MERCY DR. SUITE F
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:815-344-5072
Mailing Address - Fax:815-344-5072
Practice Address - Street 1:111 DEAN ST.
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098
Practice Address - Country:US
Practice Address - Phone:815-344-5061
Practice Address - Fax:815-344-5072
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600084101YP2500X
IL180.010572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional