Provider Demographics
NPI:1174834485
Name:KEYSER, COLBY MARA (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:COLBY
Middle Name:MARA
Last Name:KEYSER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4724
Mailing Address - Country:US
Mailing Address - Phone:215-813-2031
Mailing Address - Fax:
Practice Address - Street 1:7250 HOLLYWOOD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2016
Practice Address - Country:US
Practice Address - Phone:267-775-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005469L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist