Provider Demographics
NPI:1487187357
Name:PAOLUCCI, KESHIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:
Last Name:PAOLUCCI
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 1:2241 ALTON AVE
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4101
Mailing Address - Country:US
Mailing Address - Phone:330-853-3191
Mailing Address - Fax:
Practice Address - Street 1:1400 OAK HILL AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1018
Practice Address - Country:US
Practice Address - Phone:330-774-5562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist