Healthcare Provider Details

I. General information

NPI: 1801006622
Provider Name (Legal Business Name): SALLY L KLUETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 LAWNDALE LN N UNIT 15
PLYMOUTH MN
55446-2927
US

IV. Provider business mailing address

3605 LAWNDALE LN N UNIT 15
PLYMOUTH MN
55446-2927
US

V. Phone/Fax

Practice location:
  • Phone: 612-310-5435
  • Fax:
Mailing address:
  • Phone: 612-310-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: