Healthcare Provider Details

I. General information

NPI: 1912839978
Provider Name (Legal Business Name): KEIRA RAFFERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

620 LACEY RD STE 4
FORKED RIVER NJ
08731-2244
US

IV. Provider business mailing address

620 LACEY RD STE 4
FORKED RIVER NJ
08731-2244
US

V. Phone/Fax

Practice location:
  • Phone: 609-200-1118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTL-4797
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: