Provider Demographics
NPI:1447556147
Name:KEEFFE, MALLORY
Entity Type:Individual
Prefix:MS
First Name:MALLORY
Middle Name:
Last Name:KEEFFE
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 1:2606 SW PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-1468
Mailing Address - Country:US
Mailing Address - Phone:785-230-1428
Mailing Address - Fax:
Practice Address - Street 1:3601 SW 29TH ST
Practice Address - Street 2:SUITE 112A
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2015
Practice Address - Country:US
Practice Address - Phone:785-230-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS87811041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator