Provider Demographics
NPI:1801493390
Name:OBLENIS, KEIRA JUNE (SLP)
Entity type:Individual
Prefix:
First Name:KEIRA
Middle Name:JUNE
Last Name:OBLENIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 LINDBERG RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-7317
Mailing Address - Country:US
Mailing Address - Phone:765-464-5655
Mailing Address - Fax:765-464-5654
Practice Address - Street 1:1700 LINDBERG RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-7317
Practice Address - Country:US
Practice Address - Phone:765-464-5655
Practice Address - Fax:765-464-5654
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN220007462A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist