Provider Demographics
NPI:1275256786
Name:WHEELER, KEYLONDA KEYERA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KEYLONDA
Middle Name:KEYERA
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:KEYLONDA
Other - Middle Name:KEYERA
Other - Last Name:GRANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3010 GRASSY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3772
Mailing Address - Country:US
Mailing Address - Phone:225-938-1822
Mailing Address - Fax:
Practice Address - Street 1:223 JAMES A POLLOCK DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4937
Practice Address - Country:US
Practice Address - Phone:603-624-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist