Provider Demographics
NPI:1710238647
Name:KEATS, CARLA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:KEATS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MARIE
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:16250 NE 74TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7817
Mailing Address - Country:US
Mailing Address - Phone:425-936-1201
Mailing Address - Fax:
Practice Address - Street 1:18025 NE 116TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-2816
Practice Address - Country:US
Practice Address - Phone:425-936-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60106757235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist