Provider Demographics
NPI:1386886455
Name:KELLER, DANIEL GLEN (AUD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GLEN
Last Name:KELLER
Suffix:
Gender:M
Credentials:AUD
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Mailing Address - Street 1:5171 COTTONWOOD ST
Mailing Address - Street 2:SOUTH OFFICE BUILDING 8TH FLOOR
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5704
Mailing Address - Country:US
Mailing Address - Phone:801-507-9800
Mailing Address - Fax:801-507-9801
Practice Address - Street 1:5171 COTTONWOOD ST
Practice Address - Street 2:SOUTH OFFICE BUILDING 8TH FLOOR
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-9800
Practice Address - Fax:801-507-9801
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7278583-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist