Provider Demographics
NPI:1295327088
Name:KEENAN, AMY LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:KEENAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1746
Mailing Address - Country:US
Mailing Address - Phone:732-575-4289
Mailing Address - Fax:
Practice Address - Street 1:4 HICKORY HILL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1746
Practice Address - Country:US
Practice Address - Phone:732-575-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00789100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty