Provider Demographics
NPI:1013411560
Name:KEEFER, RACHEL (LPC, RN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KEEFER
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 N SPAULDING AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5573
Mailing Address - Country:US
Mailing Address - Phone:312-339-6213
Mailing Address - Fax:
Practice Address - Street 1:4535 N SPAULDING AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5573
Practice Address - Country:US
Practice Address - Phone:312-339-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227000553163WM1400X, 163WP0808X, 225700000X
IL178008556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist