Healthcare Provider Details

I. General information

NPI: 1962966002
Provider Name (Legal Business Name): KIMBERLY LOEPP JD, LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MAWMAN AVE
LAKE BLUFF IL
60044-2422
US

IV. Provider business mailing address

505 MAWMAN AVE
LAKE BLUFF IL
60044-2422
US

V. Phone/Fax

Practice location:
  • Phone: 828-457-1447
  • Fax:
Mailing address:
  • Phone: 828-457-1447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.041299
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32078
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number189232
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26464
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013999
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11877-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: