Provider Demographics
NPI:1295943504
Name:KELLER, ERIN NICOLE
Entity type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:NICOLE
Last Name:KELLER
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 1:325 N GIBSON RD
Mailing Address - Street 2:#225
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6710
Mailing Address - Country:US
Mailing Address - Phone:785-341-9785
Mailing Address - Fax:
Practice Address - Street 1:9800 PLACID ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4410
Practice Address - Country:US
Practice Address - Phone:702-799-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist