Provider Demographics
NPI:1174969208
Name:KEENAN, JESSICA CAROLYN BRALEY (MA, CCC-SLP/L, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CAROLYN BRALEY
Last Name:KEENAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L, IBCLC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:CAROLYN
Other - Last Name:BRALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP/L, IBCLC
Mailing Address - Street 1:910 KNOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4226
Mailing Address - Country:US
Mailing Address - Phone:815-228-7184
Mailing Address - Fax:480-697-5716
Practice Address - Street 1:910 KNOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4226
Practice Address - Country:US
Practice Address - Phone:815-228-7184
Practice Address - Fax:480-697-5716
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist