Provider Demographics
NPI:1366672966
Name:KEATING-HUDSON, SHIRLEY MARIE (SLP)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:KEATING-HUDSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:SHIRLEY
Other - Middle Name:M
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:508 RUDDER AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-5417
Mailing Address - Country:US
Mailing Address - Phone:760-420-1147
Mailing Address - Fax:
Practice Address - Street 1:508 RUDDER AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-5417
Practice Address - Country:US
Practice Address - Phone:760-420-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP16616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist