Healthcare Provider Details

I. General information

NPI: 1588898621
Provider Name (Legal Business Name): MS. JENNIFER KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 UNIVERSITY AVE SUITE # 101
EAST PALO ALTO CA
94303-2212
US

IV. Provider business mailing address

1900 UNIVERSITY AVE SUITE # 101
EAST PALO ALTO CA
94303-2212
US

V. Phone/Fax

Practice location:
  • Phone: 650-494-1000
  • Fax: 650-433-5448
Mailing address:
  • Phone: 650-494-1000
  • Fax: 650-433-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU 2521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: