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NPI Code Detail

MEDICARE: KEELY HEISER

MEDICARE: KEELY HEISER
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
1104100000XSocial WorkerCW024040PA
2104100000XSocial Worker
31041C0700XClinical Social Worker33821MN

General Provider Information

NPI Number : 1679195457
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEELY HEISER
Provider Business Mailing Address
First Line : 5125 COUNTY ROAD 101 STE 300
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-4157
Country : US
Telephone Number : 953-932-7277
Fax Number :
Provider Business Practice Location Address
First Line : 5125 COUNTY ROAD 101 STE 300
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-4157
Country : US
Telephone Number : 952-932-7277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2020
Last Update Date : 01/21/2025

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Directions to “ KEELY HEISER ” Practice Location

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