Provider Demographics
NPI:1528382819
Name:KEEFER, LACRISSA J (MS - SLP)
Entity Type:Individual
Prefix:MRS
First Name:LACRISSA
Middle Name:J
Last Name:KEEFER
Suffix:
Gender:F
Credentials:MS - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4937
Mailing Address - Country:US
Mailing Address - Phone:304-529-6205
Mailing Address - Fax:304-529-6209
Practice Address - Street 1:2001 MCCOY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4937
Practice Address - Country:US
Practice Address - Phone:304-529-6205
Practice Address - Fax:304-529-6209
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist