Provider Demographics
NPI:1730709007
Name:KLEIN-CONRAD, LISA JOY
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JOY
Last Name:KLEIN-CONRAD
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 1:204 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-1229
Mailing Address - Country:US
Mailing Address - Phone:320-291-1831
Mailing Address - Fax:
Practice Address - Street 1:117 W JAMES ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1216
Practice Address - Country:US
Practice Address - Phone:320-243-3379
Practice Address - Fax:320-243-3138
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302590101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)