Healthcare Provider Details

I. General information

NPI: 1093810186
Provider Name (Legal Business Name): ROBERT M KLINE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 FORUM BLVD SUITE 103
COLUMBIA MO
65203
US

IV. Provider business mailing address

2412 FORUM BLVD SUITE 103
COLUMBIA MO
65203
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-0725
  • Fax: 573-445-1027
Mailing address:
  • Phone: 573-445-0725
  • Fax: 573-445-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2001011864
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: