Active NPI
Michelle M Keen, SLP
- Speech-Language Pathologist
- Lackawanna, NY
National Provider Identifier
1023296100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 015128-1
- Practice address
- 1025 Ridge Rd
Lackawanna, NY 14218-1755 - Phone
- (716) 822-4781
- Fax
- (716) 825-5765
- NPI assigned
- Jan 31, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 015128-1 | NY | Primary |
Addresses
Primary practice location
1025 Ridge Rd
Lackawanna, NY 14218-1755
Mailing address
3966 Grant Ave
Hamburg, NY 14075-2923
Phone (716) 649-6288
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015128-1 | NY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childpro of Western New York | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- Lackawanna, NY
- NPI 1598974594
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201737600000",
"number": "1023296100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3966 GRANT AVE",
"city": "HAMBURG",
"state": "NY",
"postal_code": "140752923",
"telephone_number": "716-649-6288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 RIDGE RD",
"city": "LACKAWANNA",
"state": "NY",
"postal_code": "142181755",
"telephone_number": "716-822-4781",
"fax_number": "716-825-5765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEEN",
"first_name": "MICHELLE",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-31",
"last_updated": "2008-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "015128-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackawanna, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.