Provider Demographics
NPI:1477991339
Name:KELLER, AMANDA (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 DAVENPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3734
Mailing Address - Country:US
Mailing Address - Phone:989-790-7500
Mailing Address - Fax:989-790-8037
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8935
Practice Address - Country:US
Practice Address - Phone:989-573-8500
Practice Address - Fax:989-790-8037
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087031104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker