Provider Demographics
NPI:1063298966
Name:KEANEY, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KEANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 ESCH LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-1851
Mailing Address - Country:US
Mailing Address - Phone:608-957-9183
Mailing Address - Fax:
Practice Address - Street 1:4610 ESCH LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-1851
Practice Address - Country:US
Practice Address - Phone:608-957-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32590235Z00000X
WI5348-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist