MEDICARE: ANDREA KELLER

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
1	1041C0700X	Clinical Social Worker	LW61131967	WA

General Provider Information

NPI Number	:	1295239937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA KELLER

Provider Business Mailing Address
First Line	:	2239 MARTIN AVE E
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-8215
Country	:	US
Telephone Number	:	360-401-8516
Fax Number	:

Provider Business Practice Location Address
First Line	:	2239 MARTIN AVE E
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-8215
Country	:	US
Telephone Number	:	360-401-8516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	07/11/2023

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Directions to “ ANDREA KELLER ” Practice Location

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