Provider Demographics
NPI:1841936762
Name:KEYS, RACHELLE STORM (AUD)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:STORM
Last Name:KEYS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:STORM
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2515 FORESIGHT CIRCLE
Mailing Address - Street 2:SUITE
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1018
Mailing Address - Country:US
Mailing Address - Phone:970-245-2400
Mailing Address - Fax:970-242-9092
Practice Address - Street 1:2515 FORESIGHT CIRCLE
Practice Address - Street 2:SUITE
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1018
Practice Address - Country:US
Practice Address - Phone:970-245-2400
Practice Address - Fax:970-242-9092
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO231H00000X
COAUD.0001149231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000204845Medicaid