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NPI Code Detail

MEDICARE: BREANNA LYNN KELLER MSCCC-SLP

MEDICARE: BREANNA LYNN KELLER MSCCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2004021468MO

General Provider Information

NPI Number : 1164760534
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA LYNN KELLER MSCCC-SLP
Provider Business Mailing Address
First Line : 1219 RAINTREE PASS
Second Line :
City : O FALLON
State : MO
Zip : 63366-4421
Country : US
Telephone Number : 314-494-2438
Fax Number :
Provider Business Practice Location Address
First Line : 850 COUNTRY MANOR LN
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-6651
Country : US
Telephone Number : 314-434-5900
Fax Number : 314-434-3927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2013
Last Update Date : 01/19/2013

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Directions to “ BREANNA LYNN KELLER MSCCC-SLP” Practice Location

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