Provider Demographics
NPI:1568754968
Name:KEELER, JENNIFER NEWSHAM (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NEWSHAM
Last Name:KEELER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 W CITY DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9646
Mailing Address - Country:US
Mailing Address - Phone:252-331-1375
Mailing Address - Fax:252-331-1376
Practice Address - Street 1:1805 W CITY DR
Practice Address - Street 2:SUITE G
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9646
Practice Address - Country:US
Practice Address - Phone:252-331-1375
Practice Address - Fax:252-331-1376
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist