Provider Demographics
NPI:1689934325
Name:KEGLER, JOANNA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:KEGLER
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 1:2316 SHERMAN AVE UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2446
Mailing Address - Country:US
Mailing Address - Phone:773-754-5960
Mailing Address - Fax:
Practice Address - Street 1:708 CHURCH ST STE 205
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3881
Practice Address - Country:US
Practice Address - Phone:773-754-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490231051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical