Provider Demographics
NPI:1922406487
Name:KELLER, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
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 1:3710 MEADOWLAKE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-0516
Mailing Address - Country:US
Mailing Address - Phone:630-222-5509
Mailing Address - Fax:
Practice Address - Street 1:1411 W COUNTY LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-5249
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-886-5027
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004939A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist