Provider Demographics
NPI:1467538900
Name:KEOGH, NANCY J (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:KEOGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 MEDINA RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2483
Mailing Address - Country:US
Mailing Address - Phone:330-665-8225
Mailing Address - Fax:330-665-8229
Practice Address - Street 1:33 NORTH AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1925
Practice Address - Country:US
Practice Address - Phone:330-633-7083
Practice Address - Fax:330-665-8229
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3302103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH33537OtherNATIONAL REGISTER OF HEALTHCARE PROVIDERS IN PSYCHOLOGY
OH0996123 PIN0434Medicaid
OH0996123 PIN0434Medicaid