Provider Demographics
NPI:1083954747
Name:KELLER, JOSEPH BERNARDO
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BERNARDO
Last Name:KELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15440 N 99TH AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1962
Mailing Address - Country:US
Mailing Address - Phone:623-977-0506
Mailing Address - Fax:623-974-9901
Practice Address - Street 1:15440 N 99TH AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1962
Practice Address - Country:US
Practice Address - Phone:623-977-0506
Practice Address - Fax:623-974-9901
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD7695237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist