Provider Demographics
NPI:1033251277
Name:KEANE, KIMBERLY C (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:C
Last Name:KEANE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 GENESEE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5829
Mailing Address - Country:US
Mailing Address - Phone:315-792-4623
Mailing Address - Fax:315-792-6901
Practice Address - Street 1:2206 GENESEE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5829
Practice Address - Country:US
Practice Address - Phone:315-792-4623
Practice Address - Fax:315-792-6901
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001910-57231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist