MEDICARE: JODI KLEIN L.C.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	104100000X	Social Worker	34004523	IN
2	1041C0700X	Clinical Social Worker	1251	KY

General Provider Information

NPI Number	:	1790782803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI KLEIN L.C.S.W.

Provider Business Mailing Address
First Line	:	161 SAINT MATTHEWS AVE STE 17
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3145
Country	:	US
Telephone Number	:	502-897-8756
Fax Number	:	502-897-3867

Provider Business Practice Location Address
First Line	:	161 SAINT MATTHEWS AVE STE 17
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3145
Country	:	US
Telephone Number	:	502-897-8756
Fax Number	:	502-897-3867

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/11/2025

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