Healthcare Provider Details

I. General information

NPI: 1457128290
Provider Name (Legal Business Name): ALYSSA ERYN KEENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E MAIN ST.
MANKATO MN
56001
US

IV. Provider business mailing address

2043 CLARK ST APT 206
SAINT PETER MN
56082-7534
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-9359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: