MEDICARE: DEBRA LYNN KLEIN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	8969	MN

General Provider Information

NPI Number	:	1124179635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA LYNN KLEIN LICSW

Provider Business Mailing Address
First Line	:	1317 2ND ST S
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-6261
Country	:	US
Telephone Number	:	651-439-2157
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 UNIVERSITY AVE W
Second Line	:	SUITE 100
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1843
Country	:	US
Telephone Number	:	612-343-1618
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2007
Last Update Date	:	07/08/2007

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