Provider Demographics
NPI:1194313288
Name:GOFF, KEELY HOLLEY (SLP)
Entity type:Individual
Prefix:MRS
First Name:KEELY
Middle Name:HOLLEY
Last Name:GOFF
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRITTANY WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-0908
Mailing Address - Country:US
Mailing Address - Phone:803-842-0680
Mailing Address - Fax:
Practice Address - Street 1:114 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2808
Practice Address - Country:US
Practice Address - Phone:803-704-4759
Practice Address - Fax:803-728-3294
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist