Provider Demographics
NPI:1528404191
Name:KEEHLER, WANDA GAY
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:GAY
Last Name:KEEHLER
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 1:555 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-2310
Mailing Address - Country:US
Mailing Address - Phone:815-561-9003
Mailing Address - Fax:
Practice Address - Street 1:555 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-2310
Practice Address - Country:US
Practice Address - Phone:815-561-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health