Provider Demographics
NPI:1336706209
Name:KEYS, BETTY ANN (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:ANN
Last Name:KEYS
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:A
Other - Last Name:KEYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHRISTIAN THERAPIST
Mailing Address - Street 1:PO BOX 5431
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-5431
Mailing Address - Country:US
Mailing Address - Phone:619-944-7868
Mailing Address - Fax:
Practice Address - Street 1:272 E 78TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-5602
Practice Address - Country:US
Practice Address - Phone:619-944-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty