Healthcare Provider Details

I. General information

NPI: 1467136168
Provider Name (Legal Business Name): ELIZABETH KEETER M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 UNIVERSITY HALL DRIVE
BOONE NC
28607
US

IV. Provider business mailing address

6448 MAIN CIRCLE ST
CONNELLY SPRINGS NC
28612-7506
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-8660
  • Fax:
Mailing address:
  • Phone: 828-368-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30002702
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: