Healthcare Provider Details

I. General information

NPI: 1639388127
Provider Name (Legal Business Name): JUDITH A KLEPPERICH MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 PENN AVE S SUITE 105
BLOOMINGTON MN
55431-1325
US

IV. Provider business mailing address

8100 PENN AVE S SUITE 105
BLOOMINGTON MN
55431-1325
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-1303
  • Fax: 952-831-2114
Mailing address:
  • Phone: 952-831-1303
  • Fax: 952-831-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 248
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: