Provider Demographics
NPI:1639720931
Name:KELLER, KAITLYN (MSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 W 49TH TER
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-1712
Mailing Address - Country:US
Mailing Address - Phone:417-350-8831
Mailing Address - Fax:816-836-2923
Practice Address - Street 1:8702 W 49TH TER
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66203-1710
Practice Address - Country:US
Practice Address - Phone:417-350-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO011342104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker