Provider Demographics
NPI:1396574083
Name:AGUILERA, KEATON ELIZABETH (LSW)
Entity type:Individual
Prefix:MRS
First Name:KEATON
Middle Name:ELIZABETH
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3345
Mailing Address - Country:US
Mailing Address - Phone:815-564-3210
Mailing Address - Fax:
Practice Address - Street 1:1242 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-1897
Practice Address - Country:US
Practice Address - Phone:888-261-2178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker