Provider Demographics
NPI:1841188133
Name:KELLER, JANELLE (LPC-IT)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 N IRONWOOD RD
Mailing Address - Street 2:SUITE 202 #1031
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4908
Mailing Address - Country:US
Mailing Address - Phone:414-502-8095
Mailing Address - Fax:
Practice Address - Street 1:5215 N IRONWOOD RD
Practice Address - Street 2:SUITE 202 #1031
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4908
Practice Address - Country:US
Practice Address - Phone:414-502-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8514-226101YP2500X
WI819372101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty