Healthcare Provider Details

I. General information

NPI: 1992912760
Provider Name (Legal Business Name): ALLISON RUMP KEUNING PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON STREET
SAINT PAUL MN
55101
US

IV. Provider business mailing address

8170 33RD AVE MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-7900
  • Fax: 651-254-7904
Mailing address:
  • Phone: 651-254-7900
  • Fax: 651-254-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP4584
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4584
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: