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General NPI Number Information
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NPI Number | 1265562417
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Entity Type | Individual
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Provider Name | KEVIN KLOOSTERMAN M.S., LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 215 W ELM ST STE 103
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City | SYCAMORE
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State | IL
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Zip | 60178-1862
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Country | US
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Telephone | 815-895-8382
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Fax |
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Provider Business Mailing Address
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Address Line | 116 GREELEY ST
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City | SYCAMORE
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State | IL
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Zip | 60178-1728
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Country | US
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Telephone | 815-895-8382
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166000521
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License Number State | IL
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