Provider Demographics
NPI:1255415337
Name:KEENEY, LAURA ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:KEENEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:FORTENBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:13609 DEVONBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9772
Mailing Address - Country:US
Mailing Address - Phone:410-598-9914
Mailing Address - Fax:
Practice Address - Street 1:13609 DEVONBROOK RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MD
Practice Address - Zip Code:21013-9772
Practice Address - Country:US
Practice Address - Phone:410-598-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6792235Z00000X
MD04717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412347Medicaid