Provider Demographics
NPI:1962746982
Name:KEENE, HAILEY KATHERINE (ST)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:KATHERINE
Last Name:KEENE
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:
Other - Last Name:HUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3226
Practice Address - Street 1:7555 BARNETT WAY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3565
Practice Address - Country:US
Practice Address - Phone:865-938-3556
Practice Address - Fax:865-938-3558
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist