Healthcare Provider Details

I. General information

NPI: 1497896237
Provider Name (Legal Business Name): MR. JEFFREY A KLING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 N 37TH AVE
PHOENIX AZ
85019-3206
US

IV. Provider business mailing address

4015 E LAVENDER LN
PHOENIX AZ
85044-4641
US

V. Phone/Fax

Practice location:
  • Phone: 602-336-2990
  • Fax:
Mailing address:
  • Phone: 602-242-0281
  • Fax: 602-242-2791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: