Provider Demographics
NPI:1386293686
Name:KEELTY, ANNA JERGE (MSW, SUDPT)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:JERGE
Last Name:KEELTY
Suffix:
Gender:F
Credentials:MSW, SUDPT
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:JILL
Other - Last Name:JERGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 OLIVE WAY STE 1532
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1749
Mailing Address - Country:US
Mailing Address - Phone:068-527-7832
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 1532
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1749
Practice Address - Country:US
Practice Address - Phone:068-527-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610989711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical