Kathleen Keller

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SZ 4591 Issued in FL

Practice address

12276 San Jose Blvd
Suite 507
Jacksonville, FL 32223-8628

Phone

(904) 288-8910

Fax

(904) 288-8912

NPI assigned

Sep 8, 2008

Last updated

Sep 8, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Play Works Therapies, P.a.

  • Speech-Language Pathologist
  • Jacksonville, FL
  • NPI 1043257678
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220832000000",
    "number": "1497903074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12276 SAN JOSE BLVD",
            "address_2": "SUITE 507",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238628",
            "telephone_number": "904-288-8910",
            "fax_number": "904-288-8912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12276 SAN JOSE BLVD",
            "address_2": "SUITE 507",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238628",
            "telephone_number": "904-288-8910",
            "fax_number": "904-288-8912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "KATHLEEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-08",
        "last_updated": "2008-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ 4591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "SZ 4591",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barry Dean Kellem, CBHCM
• Tiffany Nicole Keller-Goolsby, MA
• Cesar Ariel Keller, M.D.
• Gregory C Keller, M.D.
• Katelyn Elizabeth Keller, PA-C
• Rachel Keller, PA-C
• Adam Christopher Kelley, PHARMD
• Beth A. Kelley, OTR.L
• Crystal Kelley
• John Roy Kelley Jr., DDS

• Speech-Language Pathologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.