Healthcare Provider Details

I. General information

NPI: 1841547635
Provider Name (Legal Business Name): HEATHER KLINKENBERG M.ED., NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 CREEKSIDE DR STE D
CLEARWATER FL
33760-4034
US

IV. Provider business mailing address

4910 CREEKSIDE DR STE D
CLEARWATER FL
33760-4034
US

V. Phone/Fax

Practice location:
  • Phone: 727-593-0003
  • Fax: 727-596-1713
Mailing address:
  • Phone: 727-593-0003
  • Fax: 727-596-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: