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General NPI Number Information
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NPI Number | 1033625645
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Entity Type | Individual
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Provider Name | LEETTA RAE KLINK LSW
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Gender | Female
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 5446 N ACADEMY BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-3644
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Country | US
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Telephone | 719-598-5555
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Fax | 719-388-2030
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Provider Business Mailing Address
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Address Line | 7898 BLACK WALNUT DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-2207
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Country | US
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Telephone | 415-425-3804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 0000951
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LSW.0009925776
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License Number State | CO
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