Provider Demographics
NPI:1356416523
Name:KLOTZ FLITTER, JILL M (PHD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:KLOTZ FLITTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N. CARROLL STREET
Mailing Address - Street 2:SUITE 710
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703
Mailing Address - Country:US
Mailing Address - Phone:608-255-4747
Mailing Address - Fax:608-268-0752
Practice Address - Street 1:16 N. CARROLL STREET
Practice Address - Street 2:SUITE 710
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703
Practice Address - Country:US
Practice Address - Phone:608-255-4747
Practice Address - Fax:608-268-0752
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2548-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical