Provider Demographics
NPI:1184702334
Name:KEYLON, BLENDA (LCSW)
Entity type:Individual
Prefix:
First Name:BLENDA
Middle Name:
Last Name:KEYLON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N WEBB RD
Mailing Address - Street 2:STE 100A
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803
Mailing Address - Country:US
Mailing Address - Phone:308-381-4161
Mailing Address - Fax:308-381-4165
Practice Address - Street 1:2121 N WEBB RD
Practice Address - Street 2:STE 100A
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-381-4161
Practice Address - Fax:308-381-4165
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2026101YM0800X
NE9431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024963100Medicaid
NE276533Medicare ID - Type Unspecified
S97202Medicare UPIN