Provider Demographics
NPI:1215177746
Name:KELLER, AMY HEATHER (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:HEATHER
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 PARK AVE S
Mailing Address - Street 2:APARTMENT 18C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6121
Mailing Address - Country:US
Mailing Address - Phone:516-782-8804
Mailing Address - Fax:
Practice Address - Street 1:280 PARK AVE S
Practice Address - Street 2:APARTMENT 18C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6121
Practice Address - Country:US
Practice Address - Phone:516-782-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017380-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist