Provider Demographics
NPI:1356522866
Name:SPIDEL, KETA L
Entity type:Individual
Prefix:
First Name:KETA
Middle Name:L
Last Name:SPIDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10949 W 500 S
Mailing Address - Street 2:
Mailing Address - City:KEMPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46049-9393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10949 W 500 S
Practice Address - Street 2:
Practice Address - City:KEMPTON
Practice Address - State:IN
Practice Address - Zip Code:46049-9393
Practice Address - Country:US
Practice Address - Phone:765-947-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004547A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist