Provider Demographics
NPI:1174831069
Name:KELLER, DREW (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:ELIZABETH
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:17706 I-30 STE 3
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2930
Mailing Address - Country:US
Mailing Address - Phone:501-315-4414
Mailing Address - Fax:501-315-3467
Practice Address - Street 1:23 MISSLE BASE RD
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-9771
Practice Address - Country:US
Practice Address - Phone:501-499-9404
Practice Address - Fax:501-575-6094
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist