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NPI Code Detail

MEDICARE: SANDRA KEEN LSW

MEDICARE: SANDRA KEEN LSW
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
1101YM0800XMental Health CounselorS0018831OH

General Provider Information

NPI Number : 1538259239
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA KEEN LSW
Provider Business Mailing Address
First Line : 452 W MARKET ST
Second Line :
City : XENIA
State : OH
Zip : 45385-2815
Country : US
Telephone Number : 937-376-8700
Fax Number : 937-376-8725
Provider Business Practice Location Address
First Line : 452 W MARKET ST
Second Line :
City : XENIA
State : OH
Zip : 45385-2815
Country : US
Telephone Number : 937-376-8700
Fax Number : 937-376-8725
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 07/08/2007

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Directions to “ SANDRA KEEN LSW” Practice Location

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