Provider Demographics
NPI:1184642746
Name:KELLER, CINDY J (MSW)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:J
Last Name:KELLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56538-0464
Mailing Address - Country:US
Mailing Address - Phone:218-205-2743
Mailing Address - Fax:
Practice Address - Street 1:1806 E FIR AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-3974
Practice Address - Country:US
Practice Address - Phone:218-205-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-02-10
Deactivation Date:2013-06-14
Deactivation Code:
Reactivation Date:2014-02-10
Provider Licenses
StateLicense IDTaxonomies
ND20621041C0700X
MN118721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AMedicare UPIN