Provider Demographics
NPI:1902660392
Name:KLINGEL, BERYL
Entity Type:Individual
Prefix:
First Name:BERYL
Middle Name:
Last Name:KLINGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SHAWNEE LN
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:OH
Mailing Address - Zip Code:44217-9227
Mailing Address - Country:US
Mailing Address - Phone:330-317-1531
Mailing Address - Fax:
Practice Address - Street 1:227 COULTER ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:OH
Practice Address - Zip Code:44217-9459
Practice Address - Country:US
Practice Address - Phone:330-435-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH370056790601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health