Provider Demographics
NPI:1932181658
Name:HARTLEY, KEEVA NICOLE (MSW LICSW)
Entity type:Individual
Prefix:MISS
First Name:KEEVA
Middle Name:NICOLE
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 METRO PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1509
Mailing Address - Country:US
Mailing Address - Phone:612-554-3740
Mailing Address - Fax:651-344-4406
Practice Address - Street 1:7800 METRO PKWY STE 300
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1509
Practice Address - Country:US
Practice Address - Phone:612-554-3740
Practice Address - Fax:651-344-4406
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN156741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical