Provider Demographics
NPI:1659994713
Name:KUBICKI, KEELEN MARY
Entity Type:Individual
Prefix:
First Name:KEELEN
Middle Name:MARY
Last Name:KUBICKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CUYLER ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-1401
Mailing Address - Country:US
Mailing Address - Phone:716-602-9309
Mailing Address - Fax:
Practice Address - Street 1:4 WEST ST
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8803
Practice Address - Country:US
Practice Address - Phone:315-986-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist