Provider Demographics
NPI:1891368635
Name:KEECH, LAURA JANE (AUD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:KEECH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 W COMMERCIAL ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4799
Mailing Address - Country:US
Mailing Address - Phone:207-874-1065
Mailing Address - Fax:207-874-1068
Practice Address - Street 1:75 W COMMERCIAL ST STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4799
Practice Address - Country:US
Practice Address - Phone:207-874-1065
Practice Address - Fax:207-874-1068
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP3516231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist