Provider Demographics
NPI:1518773571
Name:KIEPER, AMANDA L (LCPC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:KIEPER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S PERRYVILLE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2522
Mailing Address - Country:US
Mailing Address - Phone:815-978-8047
Mailing Address - Fax:
Practice Address - Street 1:555 S PERRYVILLE RD STE 115
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2522
Practice Address - Country:US
Practice Address - Phone:815-978-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.016536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health