Provider Demographics
NPI:1497070536
Name:KEETER, KELLY T (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:T
Last Name:KEETER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 PIEDMONT PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8174
Mailing Address - Country:US
Mailing Address - Phone:336-601-8604
Mailing Address - Fax:336-899-7111
Practice Address - Street 1:4160 PIEDMONT PKWY STE 101
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-601-8604
Practice Address - Fax:336-899-7111
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist