Provider Demographics
NPI:1578053021
Name:KEEHN, CAROLYN THERESA (RBT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:THERESA
Last Name:KEEHN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 CUNAT CT APT 1D
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6123
Mailing Address - Country:US
Mailing Address - Phone:224-623-4885
Mailing Address - Fax:
Practice Address - Street 1:1361 CUNAT CT APT 1D
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6123
Practice Address - Country:US
Practice Address - Phone:224-623-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-54302106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician