Provider Demographics
NPI:1083718654
Name:KLUESNER, TERI (LCSW)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:KLUESNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5044
Mailing Address - Country:US
Mailing Address - Phone:573-803-1402
Mailing Address - Fax:573-803-1405
Practice Address - Street 1:2909 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5044
Practice Address - Country:US
Practice Address - Phone:573-803-1402
Practice Address - Fax:573-803-1405
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0052281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498823103Medicaid
MO498823103Medicaid