Provider Demographics
NPI:1558329383
Name:KEIM, JOHN E (SLP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:KEIM
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13336 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1124
Mailing Address - Country:US
Mailing Address - Phone:402-330-3211
Mailing Address - Fax:402-330-5970
Practice Address - Street 1:13336 INDUSTRIAL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1124
Practice Address - Country:US
Practice Address - Phone:402-330-3211
Practice Address - Fax:402-330-5970
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477700Medicaid