Provider Demographics
NPI:1578898128
Name:KEETON, NICOLETTE ANN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLETTE
Middle Name:ANN
Last Name:KEETON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 ALLENBY DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8722
Mailing Address - Country:US
Mailing Address - Phone:937-642-0048
Mailing Address - Fax:937-642-1316
Practice Address - Street 1:453 ALLENBY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8722
Practice Address - Country:US
Practice Address - Phone:937-642-0048
Practice Address - Fax:937-642-1316
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 06000731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical