Healthcare Provider Details

I. General information

NPI: 1154952927
Provider Name (Legal Business Name): ALISSA KELLER HIS, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-5616
US

IV. Provider business mailing address

3345 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-5616
US

V. Phone/Fax

Practice location:
  • Phone: 757-631-3010
  • Fax:
Mailing address:
  • Phone: 757-631-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101002599
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-86021
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: