Active NPI
Eden Keller, LMSW
- Clinical Social Worker
- Peterson, IA
National Provider Identifier
1841032604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 117387
- Practice address
- 4509 20TH Ave
Peterson, IA 51047-7524 - Phone
- (712) 295-7601
- NPI assigned
- Jun 11, 2024
- Last updated
- Jun 11, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 117387 | IA | Primary |
Addresses
Primary practice location
4509 20TH Ave
Peterson, IA 51047-7524
Mailing address
728 Lily CT
Storm Lake, IA 50588-4603
Phone (712) 229-2721
Other practice location 1
795 N 2nd St
Cherokee, IA 51012-1289
Phone (712) 229-2721
Other practice location 2
19 2nd Ave NW
Le Mars, IA 51031-3529
Phone (712) 229-2721
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117387 | IA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Christian Services | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Peterson, IA
- NPI 1497959050
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718064000000",
"number": "1841032604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "728 LILY CT",
"city": "STORM LAKE",
"state": "IA",
"postal_code": "505884603",
"telephone_number": "712-229-2721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4509 20TH AVE",
"city": "PETERSON",
"state": "IA",
"postal_code": "510477524",
"telephone_number": "712-295-7601"
}
],
"practiceLocations": [
{
"address_1": "795 N 2nd St",
"address_purpose": "LOCATION",
"city": "Cherokee",
"state": "IA",
"postal_code": "510121289",
"country_code": "US",
"telephone_number": "712-229-2721",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "19 2nd Ave NW",
"address_purpose": "LOCATION",
"city": "Le Mars",
"state": "IA",
"postal_code": "510313529",
"country_code": "US",
"telephone_number": "712-229-2721",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KELLER",
"first_name": "EDEN",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-11",
"last_updated": "2024-06-11",
"certification_date": "2024-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IA",
"license": "117387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peterson, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.