Provider Demographics
NPI:1508355116
Name:KEPPERS, SHERI LYNN
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:LYNN
Last Name:KEPPERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1444
Mailing Address - Country:US
Mailing Address - Phone:715-804-5088
Mailing Address - Fax:715-309-5550
Practice Address - Street 1:828 E 7TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1444
Practice Address - Country:US
Practice Address - Phone:715-804-5088
Practice Address - Fax:715-309-5550
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100083744Medicaid