Healthcare Provider Details

I. General information

NPI: 1770928111
Provider Name (Legal Business Name): KEENA PATRICE SEWARD AU.D., M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 PARLIAMENT PL STE 550
LANHAM MD
20706-1883
US

IV. Provider business mailing address

10482 BALTIMORE AVE # 129
BELTSVILLE MD
20705-2321
US

V. Phone/Fax

Practice location:
  • Phone: 240-245-4370
  • Fax:
Mailing address:
  • Phone: 240-391-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number08344
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01396
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: