Provider Demographics
NPI:1053476127
Name:KLAMKIN, ALON (MS)
Entity Type:Individual
Prefix:MR
First Name:ALON
Middle Name:
Last Name:KLAMKIN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 SW JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4603
Mailing Address - Country:US
Mailing Address - Phone:541-757-0194
Mailing Address - Fax:541-757-0194
Practice Address - Street 1:508 SW JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4603
Practice Address - Country:US
Practice Address - Phone:541-757-0194
Practice Address - Fax:541-757-0194
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health