MEDICARE: JEFFREY KLEMANN LCSW

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	44SC06341200	NJ
2	1041C0700X	Clinical Social Worker	34004609	IN
3	1041C0700X	Clinical Social Worker	CW024309	PA

General Provider Information

NPI Number	:	1255464517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY KLEMANN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 4323
Second Line	:	620 8TH AVENUE
City	:	TERRE HAUTE
State	:	IN
Zip	:	47804-0323
Country	:	US
Telephone Number	:	812-231-8323
Fax Number	:	812-231-8400

Provider Business Practice Location Address
First Line	:	100 S JUNIPER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-2703
Country	:	US
Telephone Number	:	267-999-9534
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	05/30/2024

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