MEDICARE: MISS ERIN NICOLE 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	235Z00000X	Speech-Language Pathologist	SP-941	NV

General Provider Information

NPI Number	:	1295943504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ERIN NICOLE KELLER

Provider Business Mailing Address
First Line	:	325 N GIBSON RD
Second Line	:	#225
City	:	HENDERSON
State	:	NV
Zip	:	89014-6710
Country	:	US
Telephone Number	:	785-341-9785
Fax Number	:

Provider Business Practice Location Address
First Line	:	9800 PLACID ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-4410
Country	:	US
Telephone Number	:	702-799-6810
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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Directions to “ MISS ERIN NICOLE KELLER ” Practice Location

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