Healthcare Provider Details

I. General information

NPI: 1992056410
Provider Name (Legal Business Name): KATHERINE KLIPFEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 4TH ST S
FARGO ND
58103-1929
US

IV. Provider business mailing address

520 N CHESTNUT ST
RAVENNA OH
44266-2218
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2000
  • Fax:
Mailing address:
  • Phone: 330-296-5552
  • Fax: 330-296-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number543
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: