Provider Demographics
NPI:1629361142
Name:KEEHNER, LAURA ANN (CCC-SLP, BCBA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:KEEHNER
Suffix:
Gender:F
Credentials:CCC-SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-1397
Mailing Address - Country:US
Mailing Address - Phone:563-556-7878
Mailing Address - Fax:563-557-3822
Practice Address - Street 1:1011 DAVIS ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-1397
Practice Address - Country:US
Practice Address - Phone:563-556-7878
Practice Address - Fax:563-557-3822
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1-12-12137103K00000X
IA01558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist