Provider Demographics
NPI:1902133085
Name:KLEIN, JENNIFER (LCMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 HIGHWAY 96 E
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3624
Mailing Address - Country:US
Mailing Address - Phone:651-429-0661
Mailing Address - Fax:651-429-0575
Practice Address - Street 1:1310 HIGHWAY 96 E
Practice Address - Street 2:SUITE 204A
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3624
Practice Address - Country:US
Practice Address - Phone:651-429-0661
Practice Address - Fax:651-429-0575
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist