Provider Demographics
NPI:1194975649
Name:KEPROS, DIANE M (LISW, CADC, CHT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:KEPROS
Suffix:
Gender:F
Credentials:LISW, CADC, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 SILVER OAK TRL
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9224
Mailing Address - Country:US
Mailing Address - Phone:319-377-5961
Mailing Address - Fax:
Practice Address - Street 1:642 10TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3446
Practice Address - Country:US
Practice Address - Phone:319-377-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical