Healthcare Provider Details

I. General information

NPI: 1528781663
Provider Name (Legal Business Name): LAUREN ELIZABETH KLEIN CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LAUREN ELIZABETH KLEIN

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 04/11/2023
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 NOBLE DR
WOOSTER OH
44691-5351
US

IV. Provider business mailing address

8621 CRITCHFIELD RD
SHREVE OH
44676-9737
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-8498
  • Fax:
Mailing address:
  • Phone: 330-231-5971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.182043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: