Provider Demographics
NPI:1225159726
Name:KECK, CINDY L (DT)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:L
Last Name:KECK
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27W330 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1459
Mailing Address - Country:US
Mailing Address - Phone:630-399-0892
Mailing Address - Fax:630-668-2629
Practice Address - Street 1:27W330 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1459
Practice Address - Country:US
Practice Address - Phone:630-399-0892
Practice Address - Fax:630-668-2629
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCK00770706P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist