Provider Demographics
NPI:1588898621
Name:KELLER, JENNIFER
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:KELLER
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 1:1900 UNIVERSITY AVE
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2212
Mailing Address - Country:US
Mailing Address - Phone:650-494-1000
Mailing Address - Fax:650-433-5448
Practice Address - Street 1:1900 UNIVERSITY AVE
Practice Address - Street 2:SUITE # 101
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2212
Practice Address - Country:US
Practice Address - Phone:650-494-1000
Practice Address - Fax:650-433-5448
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2521231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU 2521OtherSTATE AUDIOLOGY LICENSE
CA7477OtherHEARING AID DEPENSING LICENSE