Provider Demographics
NPI:1083997282
Name:KEFFER, NICOLE RENAE (SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENAE
Last Name:KEFFER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 ELM DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8275
Mailing Address - Country:US
Mailing Address - Phone:724-627-0685
Mailing Address - Fax:724-627-0849
Practice Address - Street 1:265 ELM DR
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8275
Practice Address - Country:US
Practice Address - Phone:724-627-0685
Practice Address - Fax:724-627-0849
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist