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General NPI Number Information
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NPI Number | 1679885115
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Entity Type | Individual
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Provider Name | HEATHER R. KEPPEN (LCPC) PHD, M.ED.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 111 DEAN ST.
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City | WOODSTOCK
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State | IL
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Zip | 60098
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Country | US
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Telephone | 815-344-5061
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Fax | 815-344-5072
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Provider Business Mailing Address
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Address Line | 3923 MERCY DR. SUITE F
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City | MCHENRY
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State | IL
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Zip | 60050
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Country | US
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Telephone | 815-344-5072
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Fax | 815-344-5072
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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 | C0600084
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.010572
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License Number State | IL
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