Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003292707 |
---|---|
Provider Name | Britney Keehler |
First Address | Rochelle, IL 61068-2310 |
Second Address | Rochelle, IL 61068-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2015 |
Last Update Date | 04/08/2015 |