Provider Demographics
NPI:1598003543
Name:KELLER, WINNIE J (MS CCC/A, FAAA)
Entity Type:Individual
Prefix:
First Name:WINNIE
Middle Name:J
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS CCC/A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 W KANSAS AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6330
Mailing Address - Country:US
Mailing Address - Phone:813-404-2443
Mailing Address - Fax:
Practice Address - Street 1:9824 54TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-3708
Practice Address - Country:US
Practice Address - Phone:727-391-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY336231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter