Healthcare Provider Details

I. General information

NPI: 1407711724
Provider Name (Legal Business Name): MABEL KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12525 N PITTSBURG ST APT C105
SPOKANE WA
99218-1667
US

IV. Provider business mailing address

12525 N PITTSBURG ST APT C105
SPOKANE WA
99218-1667
US

V. Phone/Fax

Practice location:
  • Phone: 971-940-0590
  • Fax:
Mailing address:
  • Phone: 971-940-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberBDC.BD.70062868
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: