Provider Demographics
NPI:1841611522
Name:KEEN, MATTHEW (RD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KEEN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N 62ND ST
Mailing Address - Street 2:APT 1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5542
Mailing Address - Country:US
Mailing Address - Phone:717-341-4022
Mailing Address - Fax:
Practice Address - Street 1:15308 136TH AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-9241
Practice Address - Country:US
Practice Address - Phone:253-227-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1000268133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered