Healthcare Provider Details

I. General information

NPI: 1255385290
Provider Name (Legal Business Name): STELLA GRACE KEDDIE MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MCMURRAY ROAD SUITE 102
PITTSBURG PA
15241
US

IV. Provider business mailing address

37 MCMURRAY ROAD SUITE 102
PITTSBURGH PA
15241
US

V. Phone/Fax

Practice location:
  • Phone: 412-854-3602
  • Fax: 412-854-2121
Mailing address:
  • Phone: 712-854-3602
  • Fax: 412-854-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012829
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: