Provider Demographics
NPI:1689221699
Name:KEINATH, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:KEINATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-9125
Mailing Address - Country:US
Mailing Address - Phone:630-770-2827
Mailing Address - Fax:
Practice Address - Street 1:1140 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1782
Practice Address - Country:US
Practice Address - Phone:847-695-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker