MEDICARE: LOUSINDA M KEO

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1427652239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUSINDA M KEO

Provider Business Mailing Address
First Line	:	2291 W MARCH LN STE C101
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6669
Country	:	US
Telephone Number	:	916-729-3098
Fax Number	:

Provider Business Practice Location Address
First Line	:	7353 EXCALIBUR CIR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-3407
Country	:	US
Telephone Number	:	916-891-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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Directions to “ LOUSINDA M KEO ” Practice Location

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