Provider Demographics
NPI:1992703599
Name:KEELS, EDWARD W (MA CCC-A, FAAA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:W
Last Name:KEELS
Suffix:
Gender:M
Credentials:MA CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 CHESTNUT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4634
Mailing Address - Country:US
Mailing Address - Phone:215-561-0550
Mailing Address - Fax:215-561-1235
Practice Address - Street 1:1920 CHESTNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4634
Practice Address - Country:US
Practice Address - Phone:215-561-0550
Practice Address - Fax:215-561-1235
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT0002281231H00000X
NJ41YA00045200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ029040Medicare PIN