Provider Demographics
NPI:1740662113
Name:KEPNER, TREVOR
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:KEPNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 LYNN TER
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3779
Mailing Address - Country:US
Mailing Address - Phone:570-204-2161
Mailing Address - Fax:
Practice Address - Street 1:2738 LYNN TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3779
Practice Address - Country:US
Practice Address - Phone:570-204-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA14114130235Z00000X
WI4707-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist