Provider Demographics
NPI:1629668082
Name:KEEGAN, GRACE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:KEEGAN
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 1:61 MERRIMAN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1735
Mailing Address - Country:US
Mailing Address - Phone:315-378-8957
Mailing Address - Fax:
Practice Address - Street 1:3599 BIG RIDGE RD
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1709
Practice Address - Country:US
Practice Address - Phone:585-617-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist