Provider Demographics
NPI:1841032604
Name:KELLER, EDEN (LMSW)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 LILY CT
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-4603
Mailing Address - Country:US
Mailing Address - Phone:712-229-2721
Mailing Address - Fax:
Practice Address - Street 1:4509 20TH AVE
Practice Address - Street 2:
Practice Address - City:PETERSON
Practice Address - State:IA
Practice Address - Zip Code:51047-7524
Practice Address - Country:US
Practice Address - Phone:712-295-7601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1173871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical