Healthcare Provider Details

I. General information

NPI: 1417879602
Provider Name (Legal Business Name): MAGGIE LIN KEETON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 RIGGS AVE
ERLANGER KY
41018-3029
US

IV. Provider business mailing address

4449 SILVERSMITH LN
INDEPENDENCE KY
41051-8387
US

V. Phone/Fax

Practice location:
  • Phone: 859-283-8600
  • Fax:
Mailing address:
  • Phone: 859-409-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number136823
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: