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NPI Code Detail

MEDICARE: MRS. JACLYN MICHELLE KELLER LCSW

MEDICARE: MRS. JACLYN MICHELLE KELLER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC015008NC

General Provider Information

NPI Number : 1144751710
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACLYN MICHELLE KELLER LCSW
Provider Business Mailing Address
First Line : 18 KNOLL BROOK CT
Second Line :
City : GREENSBORO
State : NC
Zip : 27407-6107
Country : US
Telephone Number : 336-396-9239
Fax Number : 336-900-1238
Provider Business Practice Location Address
First Line : 3980 PREMIER DR STE 110
Second Line :
City : HIGH POINT
State : NC
Zip : 27265-8409
Country : US
Telephone Number : 336-396-9239
Fax Number : 336-900-1238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2017
Last Update Date : 12/19/2024

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