Provider Demographics
NPI:1144881657
Name:DESLICH, KEELAN DAY
Entity type:Individual
Prefix:MRS
First Name:KEELAN
Middle Name:DAY
Last Name:DESLICH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KEELAN
Other - Middle Name:MAE
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 REGIONAL DR STE 7
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8518
Mailing Address - Country:US
Mailing Address - Phone:603-410-1105
Mailing Address - Fax:
Practice Address - Street 1:57 REGIONAL DR STE 7
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8518
Practice Address - Country:US
Practice Address - Phone:603-410-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician