Provider Demographics
NPI:1972617199
Name:PEEK, KEENA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEENA
Middle Name:
Last Name:PEEK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W ROOSEVELT RD
Mailing Address - Street 2:B5-203
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5260
Mailing Address - Country:US
Mailing Address - Phone:630-221-0600
Mailing Address - Fax:630-221-0606
Practice Address - Street 1:100 W ROOSEVELT RD
Practice Address - Street 2:B5-203
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5260
Practice Address - Country:US
Practice Address - Phone:630-221-0600
Practice Address - Fax:630-221-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006625103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002225381OtherBLUE CROSS BLUE SHIELD