Provider Demographics
NPI:1760913776
Name:PUMA, KEELY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:
Last Name:PUMA
Suffix:
Gender:F
Credentials:MA, CCC-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 1422
Mailing Address - Street 2:
Mailing Address - City:NATALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70451-1422
Mailing Address - Country:US
Mailing Address - Phone:225-209-7140
Mailing Address - Fax:225-567-6847
Practice Address - Street 1:19089 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711-3603
Practice Address - Country:US
Practice Address - Phone:225-209-7140
Practice Address - Fax:225-567-6847
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist