Provider Demographics
NPI:1023632171
Name:KEISLER, AMY (MED, CCC/SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KEISLER
Suffix:
Gender:F
Credentials:MED, CCC/SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BLANKFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC/SLP
Mailing Address - Street 1:9712 WHITE BLOSSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-4178
Mailing Address - Country:US
Mailing Address - Phone:402-640-2865
Mailing Address - Fax:
Practice Address - Street 1:9712 WHITE BLOSSOM BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-4178
Practice Address - Country:US
Practice Address - Phone:402-640-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY140347235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty