Provider Demographics
NPI:1699323956
Name:KEESE, KATIE ELIZABETH (AUD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ELIZABETH
Last Name:KEESE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13934 N 59TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4168
Mailing Address - Country:US
Mailing Address - Phone:602-866-0147
Mailing Address - Fax:
Practice Address - Street 1:14506 W GRANITE VALLEY DR STE 117
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6011
Practice Address - Country:US
Practice Address - Phone:602-714-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA11943237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
14040458OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
41026738OtherAMERICAN ACADEMY OF AUDIOLOGY
AZDA11943OtherDISPENSING AUDIOLOGIST LICENSE