Samuel David Kellar

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

230146968 Issued in CA

Practice address

1210 E Bellevue Ave
Santa Rosa, CA 95407-2764

Phone

(707) 542-3671

NPI assigned

Apr 1, 2025

Last updated

Apr 1, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1743465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1730983891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 GOLF COURSE DR APT 150",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949284914",
            "telephone_number": "530-526-4113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 E BELLEVUE AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954072764",
            "telephone_number": "707-542-3671"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2121 Moraga Dr",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954046114",
            "country_code": "US",
            "telephone_number": "707-545-4283 x12298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLAR",
        "first_name": "SAMUEL",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-01",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CA",
            "license": "230146968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leroy Wayne Keiser, M.D.
• Ibrahim Keita, LVN/LPT
• Keith F Korver MD a Professional Medical Corporation
• Keith F Korver MD a Professional Medical Corporation
• Deborah Jean Keith, MFT
• Paula Marie Kelleher, R.N., N.P., M.S.N.
• Daniel Keller
• Devin Keller
• Jenness Marie Keller, MPH, RD
• Kim Annette Keller, RPH

• School Psychologist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• School Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2025; 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.