MEDICARE: MR. DANIEL ROBERT KLINKERT M.S.W.

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	101YM0800X	Mental Health Counselor	6802084808	MI
2	101Y00000X	Counselor		OR

General Provider Information

NPI Number	:	1235268160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL ROBERT KLINKERT M.S.W.

Provider Business Mailing Address
First Line	:	911 SW 21ST AVE APT 312
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1510
Country	:	US
Telephone Number	:	313-402-6983
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 SW OAK ST STE 303
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2806
Country	:	US
Telephone Number	:	971-200-0482
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	11/16/2021

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