Provider Demographics
NPI:1760507396
Name:KEENER, KATHERINE MARIE (MACCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARIE
Last Name:KEENER
Suffix:
Gender:F
Credentials:MACCC-SLP
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 902
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-0902
Mailing Address - Country:US
Mailing Address - Phone:304-920-6403
Mailing Address - Fax:
Practice Address - Street 1:WESTWOOD MEDICAL PARK
Practice Address - Street 2:WESTWOOD HEALTH CARE CENTER
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-322-5439
Practice Address - Fax:276-322-5442
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003275235Z00000X
WVWV0954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist