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General NPI Number Information
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NPI Number | 1538079660
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Entity Type | Individual
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Provider Name | LAURA KEITHLY CSWA, LSSW
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Gender | Female
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 60925 SE 15TH ST
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City | BEND
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State | OR
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Zip | 97702-0003
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Country | US
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Telephone | 541-355-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 60498 HEDGEWOOD LN
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City | BEND
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State | OR
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Zip | 97702-9382
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Country | US
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Telephone | 913-709-4456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 511803
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License Number State | OR
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