Provider Demographics
NPI:1649588278
Name:KEIB-NELSON, BARBARA KATHERINE (CCC-SLP, NYS/L)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:KATHERINE
Last Name:KEIB-NELSON
Suffix:
Gender:F
Credentials:CCC-SLP, NYS/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 ROUTE 83
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:14138-9633
Mailing Address - Country:US
Mailing Address - Phone:716-988-3291
Mailing Address - Fax:716-988-3864
Practice Address - Street 1:7755 ROUTE 83
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTON
Practice Address - State:NY
Practice Address - Zip Code:14138-9633
Practice Address - Country:US
Practice Address - Phone:716-988-3291
Practice Address - Fax:716-988-3864
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007710-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist