MEDICARE: MARY ELIZABETH KEENEY CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP0538	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891984704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH KEENEY CCC-SLP

Provider Business Mailing Address
First Line	:	2538 N 10TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1054
Country	:	US
Telephone Number	:	602-258-1653
Fax Number	:

Provider Business Practice Location Address
First Line	:	2538 N 10TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1054
Country	:	US
Telephone Number	:	602-258-1653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	10/16/2007

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