=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831753292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICKIE MICHELLE KELLER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2019
-----------------------------------------------------
Last Update Date | 09/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6428 TAPO CT
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95828-1528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-676-3497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 245195
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95824-5195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-676-3497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 120576
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------