Provider Demographics
NPI:1750553848
Name:DUDLEY, KEENYA J (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KEENYA
Middle Name:J
Last Name:DUDLEY
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:PO BOX 1881
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606
Mailing Address - Country:US
Mailing Address - Phone:662-710-4368
Mailing Address - Fax:662-267-1708
Practice Address - Street 1:713 BOOTHE ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-1715
Practice Address - Country:US
Practice Address - Phone:662-710-4368
Practice Address - Fax:662-267-1708
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist