Provider Demographics
NPI:1649460007
Name:GANTT, KESHA JANEEN (CCC/SLP)
Entity type:Individual
Prefix:
First Name:KESHA
Middle Name:JANEEN
Last Name:GANTT
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 1:8625 SAINT ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-6820
Mailing Address - Country:US
Mailing Address - Phone:301-892-0686
Mailing Address - Fax:
Practice Address - Street 1:715 E KING ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3505
Practice Address - Country:US
Practice Address - Phone:392-628-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE01-0001825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist