Healthcare Provider Details

I. General information

NPI: 1801225339
Provider Name (Legal Business Name): LORA KEIPPER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3586 WETLANDS CT
ELGIN IL
60124-5725
US

IV. Provider business mailing address

3586 WETLANDS CT
ELGIN IL
60124-5725
US

V. Phone/Fax

Practice location:
  • Phone: 630-217-7602
  • Fax:
Mailing address:
  • Phone: 630-217-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008779
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: