Provider Demographics
NPI:1922124882
Name:KELLER, GINA M (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:KELLER
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 TWIN CREEKS DR
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:JONESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17038-8319
Mailing Address - Country:US
Mailing Address - Phone:570-590-1037
Mailing Address - Fax:
Practice Address - Street 1:44 DONALDSON RD
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:PA
Practice Address - Zip Code:17981-1424
Practice Address - Country:US
Practice Address - Phone:570-695-3493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist