Healthcare Provider Details

I. General information

NPI: 1134955214
Provider Name (Legal Business Name): CRYSTAL ANN KLEMENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 POST RD
STEVENS POINT WI
54481-6134
US

IV. Provider business mailing address

630 S 36TH AVE
WAUSAU WI
54401-3930
US

V. Phone/Fax

Practice location:
  • Phone: 855-607-8242
  • Fax:
Mailing address:
  • Phone: 855-607-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128683-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: