Provider Demographics
NPI:1275265100
Name:KEEHN, JOHN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KEEHN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SHAWNEE HEALTH SERVICE AND DEVELOPMENT
Mailing Address - Street 2:109 CALIFORNIA ST, PO BOX 577
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0577
Mailing Address - Country:US
Mailing Address - Phone:618-519-9200
Mailing Address - Fax:
Practice Address - Street 1:1301 E WALNUT ST RM J120
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5004
Practice Address - Country:US
Practice Address - Phone:618-519-9200
Practice Address - Fax:618-457-8931
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490235241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical