Provider Demographics
NPI:1063280089
Name:KELTZ, CAILEY
Entity type:Individual
Prefix:
First Name:CAILEY
Middle Name:
Last Name:KELTZ
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 1:306 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-4073
Mailing Address - Country:US
Mailing Address - Phone:574-220-5598
Mailing Address - Fax:
Practice Address - Street 1:8888 KEYSTONE XING
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4609
Practice Address - Country:US
Practice Address - Phone:855-470-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician