Provider Demographics
NPI:1164179172
Name:KLINEDINST, ELLEN (MA EDS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:KLINEDINST
Suffix:
Gender:F
Credentials:MA EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16810 BARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9722
Mailing Address - Country:US
Mailing Address - Phone:574-276-1230
Mailing Address - Fax:
Practice Address - Street 1:16810 BARRINGTON CT
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9722
Practice Address - Country:US
Practice Address - Phone:574-276-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10050578103TS0200X
MISP0000000888151103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool