Provider Demographics
NPI:1083996425
Name:RAGAN-PEPPER, KALLEEN (LISW)
Entity Type:Individual
Prefix:MS
First Name:KALLEEN
Middle Name:
Last Name:RAGAN-PEPPER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 N PARK PL NE
Mailing Address - Street 2:#113
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6221
Mailing Address - Country:US
Mailing Address - Phone:319-826-6639
Mailing Address - Fax:319-826-6640
Practice Address - Street 1:5250 N PARK PL NE
Practice Address - Street 2:STE 113
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6221
Practice Address - Country:US
Practice Address - Phone:319-826-6639
Practice Address - Fax:319-826-6640
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical