Provider Demographics
NPI:1356053607
Name:PERKES, KEELY MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KEELY
Middle Name:MARIE
Last Name:PERKES
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 1:1308 E 480 S
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-7116
Mailing Address - Country:US
Mailing Address - Phone:801-390-2083
Mailing Address - Fax:
Practice Address - Street 1:6410 OLD MAIN HL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-6410
Practice Address - Country:US
Practice Address - Phone:435-797-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9404283-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist