Provider Demographics
NPI:1558484725
Name:BYROM, KEANE ALAN (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:KEANE
Middle Name:ALAN
Last Name:BYROM
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 ELMDALE PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1204
Mailing Address - Country:US
Mailing Address - Phone:214-941-2018
Mailing Address - Fax:
Practice Address - Street 1:701 S HOLLAND RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6780
Practice Address - Country:US
Practice Address - Phone:817-299-6994
Practice Address - Fax:817-453-7340
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist