Healthcare Provider Details

I. General information

NPI: 1811649148
Provider Name (Legal Business Name): RAYMOND LOUIS HEPPNER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 MILL ST
RICHMOND IL
60071-8018
US

IV. Provider business mailing address

5510 MILL ST
RICHMOND IL
60071-8018
US

V. Phone/Fax

Practice location:
  • Phone: 815-355-9994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: