Provider Demographics
NPI:1174742431
Name:KELLER, SONYA ARLENE
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:ARLENE
Last Name:KELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 S SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-3244
Mailing Address - Country:US
Mailing Address - Phone:419-562-0707
Mailing Address - Fax:
Practice Address - Street 1:1008 S SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820
Practice Address - Country:US
Practice Address - Phone:419-562-0707
Practice Address - Fax:419-562-0707
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01045231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2698264Medicaid