Healthcare Provider Details

I. General information

NPI: 1316323009
Provider Name (Legal Business Name): KEELI LAMIE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N ENGLEWOOD DR
CRAWFORDSVILLE IN
47933-9744
US

IV. Provider business mailing address

710 VETERANS MEMORIAL PKWY W APT 103
LAFAYETTE IN
47909-6966
US

V. Phone/Fax

Practice location:
  • Phone: 765-361-9767
  • Fax: 765-361-0374
Mailing address:
  • Phone: 765-585-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: