Provider Demographics
NPI:1073223517
Name:KLINE, TARA LYN (BA, MA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYN
Last Name:KLINE
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 HUDSON BLVD N STE 205
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-7162
Mailing Address - Country:US
Mailing Address - Phone:651-315-8132
Mailing Address - Fax:
Practice Address - Street 1:7250 HUDSON BLVD N STE 205
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-7162
Practice Address - Country:US
Practice Address - Phone:651-315-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist