Provider Demographics
NPI:1124179635
Name:KLEIN, DEBRA LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6261
Mailing Address - Country:US
Mailing Address - Phone:651-439-2157
Mailing Address - Fax:
Practice Address - Street 1:2324 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1843
Practice Address - Country:US
Practice Address - Phone:612-343-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN89691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical