Provider Demographics
NPI:1528128303
Name:KLIEWER, ROSELLA G
Entity type:Individual
Prefix:MS
First Name:ROSELLA
Middle Name:G
Last Name:KLIEWER
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 1:2333 HAWTHORN HILL RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-8582
Mailing Address - Country:US
Mailing Address - Phone:507-280-6054
Mailing Address - Fax:507-280-6010
Practice Address - Street 1:1700 N BROADWAY
Practice Address - Street 2:SUITE 154
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4199
Practice Address - Country:US
Practice Address - Phone:507-280-6054
Practice Address - Fax:507-280-6010
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1526103T00000X
MN436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN56241KLMedicare UPIN
MO80815Medicare UPIN