MEDICARE: NATALIE KLINGBERG

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1821715681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE KLINGBERG

Provider Business Mailing Address
First Line	:	4957 EASTWOOD GREENS ST UNIT 305
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-3744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4957 EASTWOOD GREENS ST UNIT 305
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-3744
Country	:	US
Telephone Number	:	219-742-0280
Fax Number	:

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

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	02/27/2025

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