Provider Demographics
NPI:1497360242
Name:RHIANNON, KEELY ERIN (LLMSW)
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:ERIN
Last Name:RHIANNON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:
Other - Last Name:ZURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:311 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2521
Mailing Address - Country:US
Mailing Address - Phone:810-288-9991
Mailing Address - Fax:
Practice Address - Street 1:3250 W. BIG BEAVER
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-792-3633
Practice Address - Fax:248-281-0515
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851117681104100000X
MI5502005903225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant