Provider Demographics
NPI:1316669351
Name:HUTCHINSON, KEEGHAN
Entity type:Individual
Prefix:
First Name:KEEGHAN
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KEEGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:HUTCHINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KEEGHAN HUTCHINSON
Mailing Address - Street 1:2339 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2641
Mailing Address - Country:US
Mailing Address - Phone:563-340-9570
Mailing Address - Fax:
Practice Address - Street 1:2339 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2641
Practice Address - Country:US
Practice Address - Phone:563-340-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02615L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist