Provider Demographics
NPI:1396410221
Name:KEEN, KRISTIN YAVONN (MS, CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:YAVONN
Last Name:KEEN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 KEEN RD
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-3864
Mailing Address - Country:US
Mailing Address - Phone:276-202-0039
Mailing Address - Fax:
Practice Address - Street 1:13092 MCGUFFIE RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2128
Practice Address - Country:US
Practice Address - Phone:276-739-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist