Provider Demographics
NPI:1871832709
Name:KOEN, NINA KAYE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:KAYE
Last Name:KOEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3149
Mailing Address - Country:US
Mailing Address - Phone:618-706-9050
Mailing Address - Fax:618-706-1002
Practice Address - Street 1:223 N PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3149
Practice Address - Country:US
Practice Address - Phone:618-706-9050
Practice Address - Fax:618-706-1002
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL149.0156641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health