Provider Demographics
NPI:1548597859
Name:KELLER-SOUZA, GEIZA IZABEL (SLP A)
Entity Type:Individual
Prefix:MRS
First Name:GEIZA
Middle Name:IZABEL
Last Name:KELLER-SOUZA
Suffix:
Gender:F
Credentials:SLP A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12937 BEETHOVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6874
Mailing Address - Country:US
Mailing Address - Phone:301-204-9608
Mailing Address - Fax:
Practice Address - Street 1:12937 BEETHOVEN BLVD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-204-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MD00119A2355S0801X
DCSLPA0000012355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00119AOtherSPEECH LANGUAGE PATHOLOGY ASSISTANT
DCSLPA000001OtherSPEECH LANGUAGE PATHOLOGY ASSISTANT