Provider Demographics
NPI:1487868584
Name:KEELER, KRISTIN MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MARIE
Last Name:KEELER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 GREEN BAY RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1702
Mailing Address - Country:US
Mailing Address - Phone:262-652-2365
Mailing Address - Fax:262-652-2071
Practice Address - Street 1:5024 GREEN BAY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1702
Practice Address - Country:US
Practice Address - Phone:262-652-2365
Practice Address - Fax:262-652-2071
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2277-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical