Provider Demographics
NPI:1871832709
Name:KOEN, NINA KAYE (DSW, LCSW, MSW)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:KAYE
Last Name:KOEN
Suffix:
Gender:
Credentials:DSW, LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CHITTYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3552
Mailing Address - Country:US
Mailing Address - Phone:618-498-0190
Mailing Address - Fax:618-417-6049
Practice Address - Street 1:101 CHITTYVILLE RD
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3552
Practice Address - Country:US
Practice Address - Phone:618-498-0190
Practice Address - Fax:618-417-6049
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL149.0156641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health