Provider Demographics
NPI:1174819569
Name:KEANE, CHERISE S (AUD)
Entity Type:Individual
Prefix:
First Name:CHERISE
Middle Name:S
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 1:994 OLD EAGLE SCHOOL RD STE 1017
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1802
Mailing Address - Country:US
Mailing Address - Phone:610-902-6092
Mailing Address - Fax:610-902-6081
Practice Address - Street 1:460 CREAMERY WAY STE 103
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2533
Practice Address - Country:US
Practice Address - Phone:610-384-8300
Practice Address - Fax:610-384-8885
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006214231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
226197Medicare PIN