Provider Demographics
NPI:1851533301
Name:ALSTON, KEISHA L (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:L
Last Name:ALSTON
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 1:477 CROWN DR APT 206
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8595
Mailing Address - Country:US
Mailing Address - Phone:704-996-6493
Mailing Address - Fax:
Practice Address - Street 1:477 CROWN DR APT 206
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8595
Practice Address - Country:US
Practice Address - Phone:704-996-6493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4298235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist