MEDICARE: MR. ANDREW STEVEN KEELER MA CCC 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
1	235Z00000X	Speech-Language Pathologist	01076023

General Provider Information

NPI Number	:	1588684955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW STEVEN KEELER MA CCC SLP

Provider Business Mailing Address
First Line	:	8904 E GULL LAKE DR
Second Line	:
City	:	AUGUSTA
State	:	MI
Zip	:	49012-9273
Country	:	US
Telephone Number	:	269-720-8460
Fax Number	:

Provider Business Practice Location Address
First Line	:	8904 E GULL LAKE DR
Second Line	:
City	:	AUGUSTA
State	:	MI
Zip	:	49012-9273
Country	:	US
Telephone Number	:	269-720-8460
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	06/27/2012

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Directions to “ MR. ANDREW STEVEN KEELER MA CCC SLP” Practice Location

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