Doctor Name: | BREANNA LYNN KELLER |
NPI Number: | 1164760534 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSCCC-SLP |
License Number: | 2004021468 |
Business Practice Address: | 850 Country Manor Ln Creve Coeur, MO - 631416651 |
Business Phone Number: | 3144345900 |
Business Fax Number: | 3144343927 |
Mailing Address: | 1219 Raintree Pass, O FALLON |
State: | MO |
Postal Code: | 633664421 |
Phone Number: | 3144942438 |
Fax Number: | |
NPI Enumeration Date: | 01/19/2013 |
NPI Last Update Date: | 01/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2004021468 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |