Basic Information
| Provider Information | |||||||||
| NPI: | 1790201812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEENAN | ||||||||
| FirstName: | ALLISON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 LAKE SUPERIOR DR APT 303 | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463836383 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1860 W WINCHESTER RD STE 108 | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475739486 | ||||||||
| FaxNumber: | 2199839675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2017 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 146.015982 | IL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.