Provider Demographics
NPI:1962958546
Name:KELLER, SARAH OLIVIA
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:OLIVIA
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 1:2617 14TH AVE W
Mailing Address - Street 2:APT. 2
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2150
Mailing Address - Country:US
Mailing Address - Phone:352-220-0986
Mailing Address - Fax:
Practice Address - Street 1:2617 14TH AVE WEST
Practice Address - Street 2:APT. 2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119
Practice Address - Country:US
Practice Address - Phone:352-220-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health