Provider Demographics
NPI:1073779955
Name:KLUEVER, JACKIE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:KLUEVER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 VALDRES SPRINGS CT.
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476
Mailing Address - Country:US
Mailing Address - Phone:715-393-0419
Mailing Address - Fax:714-393-0435
Practice Address - Street 1:4605 VALDRES SPRINGS CT
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4189
Practice Address - Country:US
Practice Address - Phone:715-393-0419
Practice Address - Fax:715-393-0435
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3091-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist