Provider Demographics
NPI:1679465066
Name:KEHR, CANDICE JOAN (DT)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:JOAN
Last Name:KEHR
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15228 W SPRUCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-1323
Mailing Address - Country:US
Mailing Address - Phone:815-557-9415
Mailing Address - Fax:
Practice Address - Street 1:15118 W AUSTIN DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-1331
Practice Address - Country:US
Practice Address - Phone:630-730-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty