Healthcare Provider Details

I. General information

NPI: 1336412360
Provider Name (Legal Business Name): KRISTIN M KEELER, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19806 83RD ST STE 2
BRISTOL WI
53104-6902
US

IV. Provider business mailing address

19806 83RD ST STE 2
BRISTOL WI
53104-6902
US

V. Phone/Fax

Practice location:
  • Phone: 262-652-2365
  • Fax: 262-652-2071
Mailing address:
  • Phone: 262-652-2365
  • Fax: 262-652-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTIN MARIE KEELER
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 262-652-2365