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General NPI Number Information
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NPI Number | 1194092635
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Entity Type | Individual
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Provider Name | NICOLE KRISTINE KNEPPER LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 123 W WASHINGTON ST SUITE 340
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City | OSWEGO
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State | IL
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Zip | 60543-8214
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Country | US
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Telephone | 630-383-7006
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Fax | 630-383-7006
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Provider Business Mailing Address
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Address Line | 2405 TWIN FOUNTAIN CT
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City | PLAINFIELD
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State | IL
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Zip | 60586-6397
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Country | US
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Telephone | 773-655-1198
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.004778
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License Number State | IL
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