Provider Demographics
NPI:1588190896
Name:ANDERSON, KEISHA (LSW)
Entity Type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1556
Mailing Address - Country:US
Mailing Address - Phone:937-463-2955
Mailing Address - Fax:
Practice Address - Street 1:1110 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1556
Practice Address - Country:US
Practice Address - Phone:937-463-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker