Provider Demographics
NPI:1720035306
Name:KEATLEY, MARY ANN (PHD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:KEATLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2086
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-2086
Mailing Address - Country:US
Mailing Address - Phone:303-444-3443
Mailing Address - Fax:970-221-3730
Practice Address - Street 1:777 29TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2358
Practice Address - Country:US
Practice Address - Phone:303-444-3443
Practice Address - Fax:970-221-3730
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist