Provider Demographics
NPI:1538606058
Name:O'KEEFE, KELLY E (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:E
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:E
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1118 LARKSPUR CT
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9147
Mailing Address - Country:US
Mailing Address - Phone:847-791-5094
Mailing Address - Fax:
Practice Address - Street 1:1118 LARKSPUR CT
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-9147
Practice Address - Country:US
Practice Address - Phone:847-791-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0184081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical