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General NPI Number Information
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NPI Number | 1336412360
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Entity Type | Organization
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Legal Business Name | KRISTIN M KEELER, S.C
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 4217 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53144-4518
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Country | US
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Telephone | 262-652-2365
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Fax | 262-652-2071
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Provider Business Mailing Address
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Address Line | 4217 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53144-4518
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Country | US
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Telephone | 262-652-2365
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Fax | 262-652-2071
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. KRISTIN MARIE KEELER
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Credential | PSYD
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Telephone | 262-652-2365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006391
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2277-057
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License Number State | WI
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