Provider Demographics
NPI:1689485559
Name:DENNIS, KEEGAN ROSE (MED, LPC)
Entity type:Individual
Prefix:
First Name:KEEGAN
Middle Name:ROSE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1538
Mailing Address - Country:US
Mailing Address - Phone:513-939-8833
Mailing Address - Fax:
Practice Address - Street 1:203 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1538
Practice Address - Country:US
Practice Address - Phone:440-214-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2506792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health