Provider Demographics
NPI:1104311745
Name:KEPPLE, PEGGY LONGMAN (MSW,LCSW, CADC, GC-C)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:LONGMAN
Last Name:KEPPLE
Suffix:
Gender:F
Credentials:MSW,LCSW, CADC, GC-C
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:MARIE
Other - Last Name:LONGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RIVERMEND HEALTH / POSITIVE SOBRIETY INSTITUTE
Mailing Address - Street 2:680 N. LAKESHORE DR. SUITE 800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-642-7230
Mailing Address - Fax:312-642-7055
Practice Address - Street 1:POSITIVE SOBRIETY INSTITUTE
Practice Address - Street 2:680 N. LAKE SHORE DR. SUITE 800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-642-7230
Practice Address - Fax:312-642-7055
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.022225104100000X
IL34557101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)