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General NPI Number Information
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NPI Number | 1134955214
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Entity Type | Individual
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Provider Name | CRYSTAL ANN KLEMENT
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Gender | Female
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 2417 POST RD
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City | STEVENS POINT
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State | WI
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Zip | 54481-6134
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Country | US
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Telephone | 855-607-8242
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Fax |
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Provider Business Mailing Address
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Address Line | 630 S 36TH AVE
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City | WAUSAU
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State | WI
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Zip | 54401-3930
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Country | US
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Telephone | 855-607-8242
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 128683-121
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License Number State | WI
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