Healthcare Provider Details

I. General information

NPI: 1578041349
Provider Name (Legal Business Name): KERRI T KLEIN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 7TH AVE E
WILLISTON ND
58801-4450
US

IV. Provider business mailing address

PO BOX 2291
WILLISTON ND
58802-2291
US

V. Phone/Fax

Practice location:
  • Phone: 701-572-7262
  • Fax: 701-572-8783
Mailing address:
  • Phone: 701-577-0270
  • Fax: 701-577-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2346
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: