Provider Demographics
NPI:1750073391
Name:MILLIGAN, KEELIN RYAN (PSYD)
Entity type:Individual
Prefix:
First Name:KEELIN
Middle Name:RYAN
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 PONDEROSA LN
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1020
Mailing Address - Country:US
Mailing Address - Phone:845-480-4025
Mailing Address - Fax:
Practice Address - Street 1:40 MARTIN GROSS DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1616
Practice Address - Country:US
Practice Address - Phone:215-750-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist