=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629254370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JILL R. KLINGLER, PH.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2008
-----------------------------------------------------
Last Update Date | 08/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6223 ORCHARD LN
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45213-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-478-9434
-----------------------------------------------------
Fax | 513-621-3240
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6223 ORCHARD LN
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45213-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-478-9434
-----------------------------------------------------
Fax | 513-621-3240
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JILL RIEMAN KLINGLER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 513-478-9434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 5758
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------