Healthcare Provider Details

I. General information

NPI: 1003417650
Provider Name (Legal Business Name): STEPHANIE KEIPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 N PARK PL NE STE 113
CEDAR RAPIDS IA
52402-6222
US

IV. Provider business mailing address

10495 ELLIS RD
PALO IA
52324-9799
US

V. Phone/Fax

Practice location:
  • Phone: 319-320-7506
  • Fax:
Mailing address:
  • Phone: 319-310-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number100532
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: