Provider Demographics
NPI:1154443927
Name:KLUENDER, MARCUS C (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:C
Last Name:KLUENDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 COFFEE ROAD
Mailing Address - Street 2:STE C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-572-1301
Mailing Address - Fax:209-572-2469
Practice Address - Street 1:1518 COFFEE ROAD
Practice Address - Street 2:STE C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-572-1301
Practice Address - Fax:209-572-2469
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4660103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC4114OtherMFCC
CAOOPL4660Medicare ID - Type Unspecified