Healthcare Provider Details

I. General information

NPI: 1447701206
Provider Name (Legal Business Name): KEELY ANN BILL MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 US 31W BYP
BOWLING GREEN KY
42101-1775
US

IV. Provider business mailing address

240 STAGE COACH AVE
ALVATON KY
42122-9578
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-7768
  • Fax: 270-781-9480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number172986
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number167274
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: