Healthcare Provider Details

I. General information

NPI: 1104317288
Provider Name (Legal Business Name): JANAKI SPICKARD-KEELER MSS, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 16TH ST
PHILADELPHIA PA
19102
US

IV. Provider business mailing address

2227 MULBERRY CT
LANSDALE PA
19446-4369
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-8244
  • Fax:
Mailing address:
  • Phone: 215-776-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW133928
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: