Provider Demographics
NPI:1194473033
Name:KEETCH, KJIRSTEN CYNTHIA NOEL (SLP)
Entity Type:Individual
Prefix:
First Name:KJIRSTEN
Middle Name:CYNTHIA NOEL
Last Name:KEETCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KJIRSTEN
Other - Middle Name:CYNTHIA NOEL
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7213 N SILVER CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7213 N SILVER CREEK WAY
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5191
Practice Address - Country:US
Practice Address - Phone:801-980-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11785473-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist