Provider Demographics
NPI:1558155325
Name:KEENE, KALLIE ANNE
Entity type:Individual
Prefix:
First Name:KALLIE
Middle Name:ANNE
Last Name:KEENE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 PROFILE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:NH
Mailing Address - Zip Code:03574-5802
Mailing Address - Country:US
Mailing Address - Phone:339-933-3889
Mailing Address - Fax:
Practice Address - Street 1:170 KEARSARGE RD
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5331
Practice Address - Country:US
Practice Address - Phone:603-356-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician