Provider Demographics
NPI:1013411883
Name:KEILMAN, JASON WAYNE (ACA, NBC-HIS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:WAYNE
Last Name:KEILMAN
Suffix:
Gender:M
Credentials:ACA, NBC-HIS
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:WAYNE
Other - Last Name:KEILMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACA
Mailing Address - Street 1:10982 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3058
Mailing Address - Country:US
Mailing Address - Phone:734-261-6300
Mailing Address - Fax:734-261-5116
Practice Address - Street 1:10982 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3058
Practice Address - Country:US
Practice Address - Phone:734-261-6300
Practice Address - Fax:734-261-5116
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501003237237700000X, 2355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist