Provider Demographics
NPI:1538484365
Name:KELLER, ROBIN J (MS, SLP/CCC)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:J
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS, SLP/CCC
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:J
Other - Last Name:DORANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP/CFY
Mailing Address - Street 1:1000 SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3366
Mailing Address - Country:US
Mailing Address - Phone:817-921-5020
Mailing Address - Fax:817-921-5022
Practice Address - Street 1:1000 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3366
Practice Address - Country:US
Practice Address - Phone:817-921-5020
Practice Address - Fax:817-921-5022
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114180235Z00000X
TX354272355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX676535Medicare Oscar/Certification
TX456606Medicare Oscar/Certification