MEDICARE: CRYSTAL ANN KLEMENT LCSW

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
1	1041C0700X	Clinical Social Worker	12920-123	WI

General Provider Information

NPI Number	:	1134955214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL ANN KLEMENT LCSW

Provider Business Mailing Address
First Line	:	630 S 36TH AVE
Second Line	:
City	:	WAUSAU
State	:	WI
Zip	:	54401-3930
Country	:	US
Telephone Number	:	855-607-8242
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 POST RD
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-6134
Country	:	US
Telephone Number	:	855-607-8242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	04/26/2026

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