Healthcare Provider Details

I. General information

NPI: 1366054793
Provider Name (Legal Business Name): CAROLYN KEENEY M.A., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR STE 215A
DAVIE FL
33328-5310
US

IV. Provider business mailing address

4741 NE 28TH AVE
FORT LAUDERDALE FL
33308-4822
US

V. Phone/Fax

Practice location:
  • Phone: 954-319-7609
  • Fax:
Mailing address:
  • Phone: 443-745-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: