Healthcare Provider Details

I. General information

NPI: 1386576437
Provider Name (Legal Business Name): MR. AIDEN NATHANIEL KELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 JUANA AVE
SAN LEANDRO CA
94577-4811
US

IV. Provider business mailing address

9880 NE GIBBS DR APT 427
BEAVERTON OR
97006-7084
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-4015
  • Fax:
Mailing address:
  • Phone: 907-545-4794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: