Provider Demographics
NPI:1164694667
Name:KLEMM, EILEEN A (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:A
Last Name:KLEMM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:A
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4849 WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2766
Mailing Address - Country:US
Mailing Address - Phone:651-330-1902
Mailing Address - Fax:
Practice Address - Street 1:100 COBBLESTONE LN
Practice Address - Street 2:COURAGE CENTER BURNSVILLE
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4578
Practice Address - Country:US
Practice Address - Phone:952-898-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist