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General NPI Number Information
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NPI Number | 1073922357
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Entity Type | Individual
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Provider Name | VICKI KLATT ED.S.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 55707 INDUSTRIAL DR
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City | BRIDGEPORT
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State | OH
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Zip | 43912-1516
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Country | US
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Telephone | 740-635-0853
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Fax | 740-635-6008
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Provider Business Mailing Address
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Address Line | 55707 INDUSTRIAL DR
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City | BRIDGEPORT
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State | OH
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Zip | 43912-1516
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Country | US
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Telephone | 740-635-0853
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Fax | 740-635-6008
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | OH1313976
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License Number State | OH
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