Provider Demographics
NPI:1225203565
Name:KEENAN, GREGORY (BC-HIS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:KEENAN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 CHRISTY WAY S
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2225
Mailing Address - Country:US
Mailing Address - Phone:989-799-6603
Mailing Address - Fax:989-799-2971
Practice Address - Street 1:3120 CHRISTY WAY S
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2225
Practice Address - Country:US
Practice Address - Phone:989-799-6603
Practice Address - Fax:989-799-2971
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002025237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist