Provider Demographics
NPI:1720896475
Name:KEEN, JESSICA (HIM)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:KEEN
Suffix:
Gender:F
Credentials:HIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 CROSSING CT STE B
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-5900
Mailing Address - Country:US
Mailing Address - Phone:217-693-7085
Mailing Address - Fax:
Practice Address - Street 1:2916 CROSSING CT STE B
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-5900
Practice Address - Country:US
Practice Address - Phone:217-693-7085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3618237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist