Provider Demographics
NPI:1952433245
Name:KEUP, PAMELA L (SLP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:L
Last Name:KEUP
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:PSC 561 BOX 1546
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96310
Mailing Address - Country:US
Mailing Address - Phone:011-818-2779
Mailing Address - Fax:
Practice Address - Street 1:PSC 561 BOX 1546
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96310
Practice Address - Country:US
Practice Address - Phone:011-818-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 4324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist