Provider Demographics
NPI:1861379752
Name:KEENE, JENNIFER A (SSP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:KEENE
Suffix:
Gender:F
Credentials:SSP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:KUSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-1746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 OSAGE ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1746
Practice Address - Country:US
Practice Address - Phone:708-289-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool