Provider Demographics
NPI:1669789616
Name:KEEDY, NICOLE HOCHHAUSEN (PHD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:HOCHHAUSEN
Last Name:KEEDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:HOCHHAUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1500 ASSOCIATES DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2201
Mailing Address - Country:US
Mailing Address - Phone:563-584-4100
Mailing Address - Fax:563-584-4110
Practice Address - Street 1:200 MERCY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7303
Practice Address - Country:US
Practice Address - Phone:563-584-3500
Practice Address - Fax:563-584-3520
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001181103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist