Provider Demographics
NPI:1982156931
Name:KEENEY, JULIE (MS, SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KEENEY
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 SHAMROCK AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1060 D ST W
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:OR
Practice Address - Zip Code:97918-1107
Practice Address - Country:US
Practice Address - Phone:541-473-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15642235Z00000X
IDSLP-3054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist