Provider Demographics
NPI:1073171922
Name:KLEBAN-ALLEN, KARIN ANNE
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:ANNE
Last Name:KLEBAN-ALLEN
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 1:282 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RUN
Mailing Address - State:NJ
Mailing Address - Zip Code:08092
Mailing Address - Country:US
Mailing Address - Phone:609-618-0178
Mailing Address - Fax:
Practice Address - Street 1:282 OAK AVE
Practice Address - Street 2:
Practice Address - City:CEDAR RUN
Practice Address - State:NJ
Practice Address - Zip Code:08092
Practice Address - Country:US
Practice Address - Phone:609-618-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ252Y00000X
NJ41YS00617400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider Agency