Healthcare Provider Details

I. General information

NPI: 1497072391
Provider Name (Legal Business Name): DAWN D KLUG PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2010
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 WALNUT ST
WEST BEND WI
53095-3331
US

IV. Provider business mailing address

4419 COUNTRY AIRE DR
CEDARBURG WI
53012-9603
US

V. Phone/Fax

Practice location:
  • Phone: 414-418-4463
  • Fax: 262-384-3747
Mailing address:
  • Phone: 262-388-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1586933
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15869
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: