Healthcare Provider Details

I. General information

NPI: 1588138192
Provider Name (Legal Business Name): JANETTE KLEPACKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 PELHAM RD
GREENVILLE SC
29615-4101
US

IV. Provider business mailing address

751 EAST GEORGIA ST
WOODRUFF SC
29388
US

V. Phone/Fax

Practice location:
  • Phone: 732-770-2205
  • Fax:
Mailing address:
  • Phone: 864-476-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-18-9111
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: