Provider Demographics
NPI:1043826472
Name:KLEIN, SAMANTHA JO (ASW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:KLEIN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:HOLLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3345 CAPRICORN WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2354
Mailing Address - Country:US
Mailing Address - Phone:530-917-5326
Mailing Address - Fax:
Practice Address - Street 1:2135 PINE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2690
Practice Address - Country:US
Practice Address - Phone:530-917-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW923821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical