Provider Demographics
NPI:1487289203
Name:KEATING, KARLIE ROSE
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:ROSE
Last Name:KEATING
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 1:60 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1100
Mailing Address - Country:US
Mailing Address - Phone:774-222-5693
Mailing Address - Fax:
Practice Address - Street 1:60 DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1100
Practice Address - Country:US
Practice Address - Phone:774-222-5693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant