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NPI Code Detail

MEDICARE: JESSIE KLIMKEWICZ

MEDICARE: JESSIE KLIMKEWICZ
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
1106S00000XBehavior Technician
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.172517OH

General Provider Information

NPI Number : 1417587668
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSIE KLIMKEWICZ
Provider Business Mailing Address
First Line : 2775 STATE ROUTE 39
Second Line :
City : SHELBY
State : OH
Zip : 44875-9466
Country : US
Telephone Number : 419-747-3322
Fax Number :
Provider Business Practice Location Address
First Line : 741 SCHOLL RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44907-1587
Country : US
Telephone Number : 419-756-1717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2020
Last Update Date : 03/27/2025

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Directions to “ JESSIE KLIMKEWICZ ” Practice Location

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