Provider Demographics
NPI:1477705960
Name:MERCIER-KELLER, MAUREEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MERCIER-KELLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3009
Mailing Address - Country:US
Mailing Address - Phone:585-336-3055
Mailing Address - Fax:585-336-3072
Practice Address - Street 1:350 COOPER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3009
Practice Address - Country:US
Practice Address - Phone:585-336-3055
Practice Address - Fax:585-336-3072
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012571-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30-0213081OtherTAX ID