Provider Demographics
NPI:1609537646
Name:KEITH, ODILIA (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ODILIA
Middle Name:
Last Name:KEITH
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 1:828 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-2698
Mailing Address - Country:US
Mailing Address - Phone:281-452-8006
Mailing Address - Fax:
Practice Address - Street 1:828 SHELDON RD
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-2698
Practice Address - Country:US
Practice Address - Phone:281-452-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist