Provider Demographics
NPI:1063261121
Name:KELLER, JODEE G (LICSW)
Entity type:Individual
Prefix:
First Name:JODEE
Middle Name:G
Last Name:KELLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 LESCHI WAY
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-9608
Mailing Address - Country:US
Mailing Address - Phone:253-219-5003
Mailing Address - Fax:
Practice Address - Street 1:790 LESCHI WAY
Practice Address - Street 2:
Practice Address - City:FOX ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98333-9608
Practice Address - Country:US
Practice Address - Phone:253-219-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000055261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical