Healthcare Provider Details

I. General information

NPI: 1619499472
Provider Name (Legal Business Name): SHELLEY A KELLER BSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W BACON ST
HILLSDALE MI
49242-1546
US

IV. Provider business mailing address

310 W BACON ST
HILLSDALE MI
49242-1546
US

V. Phone/Fax

Practice location:
  • Phone: 517-437-0990
  • Fax:
Mailing address:
  • Phone: 517-437-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1450670
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801103781
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: