Provider Demographics
NPI:1104431709
Name:KEATON, ERIKA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:KEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3233
Mailing Address - Country:US
Mailing Address - Phone:612-702-8295
Mailing Address - Fax:
Practice Address - Street 1:2042 WOODDALE DR STE 125
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4394
Practice Address - Country:US
Practice Address - Phone:651-689-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health