Provider Demographics
NPI:1568849099
Name:KELLER, LEAH ROSE (LMSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ROSE
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 1:7912 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8955
Mailing Address - Country:US
Mailing Address - Phone:269-369-1869
Mailing Address - Fax:
Practice Address - Street 1:7912 S 8TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8955
Practice Address - Country:US
Practice Address - Phone:269-361-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092157104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801092157OtherLMSW