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General NPI Number Information
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NPI Number | 1134865322
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Entity Type | Individual
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Provider Name | KIMBERLY LOUISE KEON
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Gender | Female
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 350 INDIAN BOUNDARY RD
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City | CHESTERTON
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State | IN
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Zip | 46304-1511
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Country | US
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Telephone | 219-308-1570
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Fax |
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Provider Business Mailing Address
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Address Line | 7035 KNICKERBOCKER PKWY
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City | HAMMOND
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State | IN
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Zip | 46323-2028
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Country | US
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Telephone | 773-655-2924
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87900033A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 88001118A
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License Number State | IN
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