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NPI Code Detail

MEDICARE: MR. JEFFREY J KLUNK MS

MEDICARE: MR. JEFFREY J KLUNK MS
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
1103T00000XPsychologistPS004321LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1188819OTHERPAVALUE OPTIONS
250000097OTHERPACAPITAL BLUE CROSS

General Provider Information

NPI Number : 1255382305
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY J KLUNK MS
Provider Business Mailing Address
First Line : 306 N 7TH ST
Second Line :
City : COLUMBIA
State : PA
Zip : 17512-2137
Country : US
Telephone Number : 717-560-3782
Fax Number : 717-560-3787
Provider Business Practice Location Address
First Line : 306 N 7TH ST
Second Line :
City : COLUMBIA
State : PA
Zip : 17512-2137
Country : US
Telephone Number : 717-560-3782
Fax Number : 717-560-3787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2006
Last Update Date : 04/13/2015

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