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General NPI Number Information
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NPI Number | 1255675112
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Entity Type | Individual
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Provider Name | DEBORAH J KLECKER LPC, MFT-IT, SAC-IT
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/29/2013
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Provider Practice Location Address
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Address Line | 970 S SILVER LAKE ST SUITE #103
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3802
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Country | US
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Telephone | 262-567-7377
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Fax | 262-567-7377
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Provider Business Mailing Address
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Address Line | W6269 TRAIN RD
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City | WATERTOWN
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State | WI
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Zip | 53098-3909
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Country | US
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Telephone | 262-893-7870
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Fax | 262-567-7377
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15898-130
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 178-228
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4958-125
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License Number State | WI
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