Provider Demographics
NPI:1992958276
Name:KEYES, SHANNON M (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:KEYES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 COUNTY ROUTE 17
Mailing Address - Street 2:
Mailing Address - City:LACONA
Mailing Address - State:NY
Mailing Address - Zip Code:13083-4107
Mailing Address - Country:US
Mailing Address - Phone:315-387-6395
Mailing Address - Fax:
Practice Address - Street 1:7018 COUNTY ROUTE 17
Practice Address - Street 2:
Practice Address - City:LACONA
Practice Address - State:NY
Practice Address - Zip Code:13083-4107
Practice Address - Country:US
Practice Address - Phone:315-387-6395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016192-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist