Healthcare Provider Details

I. General information

NPI: 1326721333
Provider Name (Legal Business Name): ALYSSA KEUNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 MEXICO RD
SAINT PETERS MO
63376-1119
US

IV. Provider business mailing address

4762 TITAN CT
SAINT LOUIS MO
63128-3013
US

V. Phone/Fax

Practice location:
  • Phone: 314-835-8029
  • Fax:
Mailing address:
  • Phone: 314-835-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2023032082
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: