Provider Demographics
NPI:1386508463
Name:FIELDS-SMALL, KEINA MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KEINA
Middle Name:MARIE
Last Name:FIELDS-SMALL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ROSEANNA RD
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1231
Mailing Address - Country:US
Mailing Address - Phone:315-727-9927
Mailing Address - Fax:
Practice Address - Street 1:130 ROSEANNA RD
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1231
Practice Address - Country:US
Practice Address - Phone:315-727-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-12
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003640235Z00000X
NY014001-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist