Provider Information for 1477394104
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SUZANNE CLAIRE KLEKNER LCSW
Sex: Female
NPI: 1477394104
Last Updated: 2024-06-05
Certification Date: 2024-06-05
Certification Date: 2024-06-05
Details
| Name | Value | ||||||||||||
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| NPI | 1477394104 | ||||||||||||
| Enumeration Date | 2024-06-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 200 CARINA DR SANTA ROSA, CA 95401-5816 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 200 CARINA DR SANTA ROSA, CA 95401-5816 United States Phone: 773-315-8388 | Fax: | ||||||||||||
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