Individual
MRS. JAMIE ELAINE KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADCIII
Contact information
Practice address
4800 S 10TH ST, MILWAUKEE, WI 53221-2412
(414) 744-5370
(414) 744-9052
Mailing address
W21W22956 HILLSIDE DRIVE, WAUKESHA, WI 53186
(262) 574-6951
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1644
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39375900
—
WI
Enumeration date
02/07/2007
Last updated
07/09/2007
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