Provider Demographics
NPI:1235373887
Name:KEENEY, ERIN KAYE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:KAYE
Last Name:KEENEY
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Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:5225 PENTECOST DR
Mailing Address - Street 2:SUITE 26
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9284
Mailing Address - Country:US
Mailing Address - Phone:209-576-7280
Mailing Address - Fax:209-576-7275
Practice Address - Street 1:5225 PENTECOST DR
Practice Address - Street 2:SUITE 26
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9284
Practice Address - Country:US
Practice Address - Phone:209-576-7280
Practice Address - Fax:209-576-7275
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13753OtherCA STATE LICENSE TO PRACTICE SPEECH PATHOLOGY FROM THE CA DEPT. OF CONSMER AFFAI