Provider Demographics
NPI:1376423632
Name:KEILSON, JUDITH M
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:KEILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MATI
Other - Middle Name:
Other - Last Name:KEILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:576 CEDAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5110 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1534
Practice Address - Country:US
Practice Address - Phone:646-656-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist