MEDICARE: MS. KAY F KLINKENBERG LMFT

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	106H00000X	Marriage & Family Therapist		IL

General Provider Information

NPI Number	:	1487759148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAY F KLINKENBERG LMFT

Provider Business Mailing Address
First Line	:	1124 SOUTH FIFTH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703
Country	:	US
Telephone Number	:	217-744-3525
Fax Number	:	217-744-3535

Provider Business Practice Location Address
First Line	:	1124 SOUTH FIFTH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703
Country	:	US
Telephone Number	:	217-744-3525
Fax Number	:	217-744-3535

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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