Individual provider Active NPI

Amanda Keene

  • Behavior Analyst
  • Saint Cloud, MN
National Provider Identifier
1528619251
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
LBA0171 Issued in MN
Practice address
3721 23Rd St S Ste 201
Saint Cloud, MN 56301-6199
Phone
(605) 271-2690
NPI assigned
Sep 24, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Behavior Analyst 103K00000X LBA0171 MN Primary

Addresses

Primary practice location

3721 23Rd St S Ste 201
Saint Cloud, MN 56301-6199

Mailing address

1105 W Russell St
Sioux Falls, SD 57104-1322
Phone (605) 271-2690

Other practice location 1

108 Doctors Park
Saint Cloud, MN 56303-1207
Phone (320) 774-3915

Other practice location 2

205 14th Ave E
Sartell, MN 56377-4500
Phone (320) 774-3436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LBA0171MNMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Northway Academy, Inc. PastSince Sep 1, 2019 Accepting new patients
Northway Academy, Inc. PastSince Sep 1, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1528619251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 W RUSSELL ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571041322",
            "telephone_number": "605-271-2690",
            "fax_number": "605-271-3956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3721 23RD ST S STE 201",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563016199",
            "telephone_number": "605-271-2690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 Doctors Park",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563031207",
            "country_code": "US",
            "telephone_number": "320-774-3915",
            "fax_number": "320-774-3918",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "205 14th Ave E",
            "address_purpose": "LOCATION",
            "city": "Sartell",
            "state": "MN",
            "postal_code": "563774500",
            "country_code": "US",
            "telephone_number": "320-774-3436",
            "fax_number": "320-774-3440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEENE",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-24",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MN",
            "license": "LBA0171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.