Provider Demographics
NPI:1346672953
Name:KNIPP, KEVIN G (LMFT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:KNIPP
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 S WASHINGTON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7967
Mailing Address - Country:US
Mailing Address - Phone:331-215-4903
Mailing Address - Fax:
Practice Address - Street 1:1155 S WASHINGTON ST STE 104
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7967
Practice Address - Country:US
Practice Address - Phone:331-215-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist