Provider Demographics
NPI:1144600156
Name:KEO, ABBY MARIE (MS CCC - SLP)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:MARIE
Last Name:KEO
Suffix:
Gender:F
Credentials:MS CCC - SLP
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:MARIE
Other - Last Name:LANTZY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CF- SLP
Mailing Address - Street 1:9907 KINGSBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1695
Mailing Address - Country:US
Mailing Address - Phone:703-774-4501
Mailing Address - Fax:
Practice Address - Street 1:1026 CROMWELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3318
Practice Address - Country:US
Practice Address - Phone:410-583-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2202007857OtherVIRGINIA BOARD OF SPEECH-LANGUAGE PATHOLOGY