Healthcare Provider Details

I. General information

NPI: 1609973247
Provider Name (Legal Business Name): KAREN S. KEENE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 THOMPSON LN N
VINE GROVE KY
40175-6385
US

IV. Provider business mailing address

1190 THOMPSON LN N
VINE GROVE KY
40175-6385
US

V. Phone/Fax

Practice location:
  • Phone: 270-828-6380
  • Fax: 270-828-6380
Mailing address:
  • Phone: 270-828-6380
  • Fax: 270-828-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY-2703
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: