Provider Demographics
NPI:1457669277
Name:MAUREEN MCKEOWN, SPEECH PATHOLOGIST, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MAUREEN MCKEOWN, SPEECH PATHOLOGIST, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:415-672-3653
Mailing Address - Street 1:3150 18TH ST
Mailing Address - Street 2:SUITE 264 BOX 302
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2074
Mailing Address - Country:US
Mailing Address - Phone:415-672-3653
Mailing Address - Fax:
Practice Address - Street 1:3150 18TH ST
Practice Address - Street 2:SUITE 264 BOX 302
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2074
Practice Address - Country:US
Practice Address - Phone:415-672-3653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 5268261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech