Provider Demographics
NPI:1043894496
Name:FITTEN, KEVA
Entity type:Individual
Prefix:
First Name:KEVA
Middle Name:
Last Name:FITTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 MORRIS AVE NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-5247
Mailing Address - Country:US
Mailing Address - Phone:319-431-6890
Mailing Address - Fax:
Practice Address - Street 1:16116 INVERRARY LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61705-5580
Practice Address - Country:US
Practice Address - Phone:319-431-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor