Healthcare Provider Details

I. General information

NPI: 1790782803
Provider Name (Legal Business Name): JODI KLEIN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 SAINT MATTHEWS AVE STE 17
LOUISVILLE KY
40207-3145
US

IV. Provider business mailing address

161 SAINT MATTHEWS AVE STE 17
LOUISVILLE KY
40207-3145
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-8756
  • Fax: 502-897-3867
Mailing address:
  • Phone: 502-897-8756
  • Fax: 502-897-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34004523
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1251
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: