Provider Demographics
NPI:1649838368
Name:KEENA, KURT
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:KEENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HARRIET DR
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1907
Mailing Address - Country:US
Mailing Address - Phone:973-487-8780
Mailing Address - Fax:
Practice Address - Street 1:27 HARRIET DR
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1907
Practice Address - Country:US
Practice Address - Phone:973-487-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP0003362235Z00000X
NJ41YS00889700235Z00000X
MO2018002451235Z00000X
CA28710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist