Provider Demographics
NPI:1841441391
Name:HAMILTON, KEELY LYN (AUD)
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:LYN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 OAKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1323
Mailing Address - Country:US
Mailing Address - Phone:248-250-4327
Mailing Address - Fax:
Practice Address - Street 1:5701 BOW POINTE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3198
Practice Address - Country:US
Practice Address - Phone:248-620-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000190231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist