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NPI Code Detail

MEDICARE: JACKIE KLUEVER MS,CCC-SLP

MEDICARE: JACKIE KLUEVER MS,CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist3091-154WI

General Provider Information

NPI Number : 1073779955
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE KLUEVER MS,CCC-SLP
Provider Business Mailing Address
First Line : 4605 VALDRES SPRINGS CT.
Second Line :
City : WESTON
State : WI
Zip : 54476
Country : US
Telephone Number : 715-393-0419
Fax Number : 714-393-0435
Provider Business Practice Location Address
First Line : 4605 VALDRES SPRINGS CT
Second Line :
City : WESTON
State : WI
Zip : 54476-4189
Country : US
Telephone Number : 715-393-0419
Fax Number : 715-393-0435
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2008
Last Update Date : 08/25/2010

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Directions to “ JACKIE KLUEVER MS,CCC-SLP” Practice Location

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