Provider Demographics
NPI:1194092635
Name:KNEPPER, NICOLE KRISTINE (LCPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTINE
Last Name:KNEPPER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 TWIN FOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6397
Mailing Address - Country:US
Mailing Address - Phone:773-655-1198
Mailing Address - Fax:
Practice Address - Street 1:123 W WASHINGTON ST
Practice Address - Street 2:SUITE 340
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8214
Practice Address - Country:US
Practice Address - Phone:630-383-7006
Practice Address - Fax:630-383-7006
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional