Healthcare Provider Details

I. General information

NPI: 1194393108
Provider Name (Legal Business Name): KAITLYN KELLER MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 AICHOLTZ RD
CINCINNATI OH
45244-1447
US

IV. Provider business mailing address

4629 AICHOLTZ RD STE 2
CINCINNATI OH
45244-1560
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2310080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: