Provider Demographics
NPI:1780426593
Name:KELLER, COBY (SLPA)
Entity type:Individual
Prefix:
First Name:COBY
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 CARAVEL DR APT 934
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3779
Mailing Address - Country:US
Mailing Address - Phone:405-482-2841
Mailing Address - Fax:
Practice Address - Street 1:401 S COLTRANE RD STE 260
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6722
Practice Address - Country:US
Practice Address - Phone:580-318-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSLPA3472355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant