MEDICARE: ASHLYN RENE KELTNER 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
1	104100000X	Social Worker	33010295A	IN
2	1041C0700X	Clinical Social Worker	34011141A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01	OTHER		N/A

General Provider Information

NPI Number	:	1821741133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLYN RENE KELTNER LCSW

Provider Business Mailing Address
First Line	:	4020 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-3310
Country	:	US
Telephone Number	:	219-595-2341
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-3310
Country	:	US
Telephone Number	:	219-595-2341
Fax Number	:

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

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	12/03/2024

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