Provider Demographics
NPI:1215359534
Name:KECK, DEBORAH ANN (MS, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:KECK
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 S FAIRMONT AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5100
Mailing Address - Country:US
Mailing Address - Phone:209-333-8510
Mailing Address - Fax:
Practice Address - Street 1:3 MEDICAL PLAZA DR STE 220
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3088
Practice Address - Country:US
Practice Address - Phone:916-773-7920
Practice Address - Fax:916-773-7919
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1094231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU1094Medicaid
CAAU1094OtherSTATE LICENSE