Provider Demographics
NPI:1467651927
Name:KEATING, LISA BEEKMAN (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BEEKMAN
Last Name:KEATING
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 ASTER CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2562
Mailing Address - Country:US
Mailing Address - Phone:910-470-4479
Mailing Address - Fax:910-791-7507
Practice Address - Street 1:3537 ASTER CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2562
Practice Address - Country:US
Practice Address - Phone:910-470-4479
Practice Address - Fax:910-791-7507
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7401002Medicaid