Provider Demographics
NPI:1326466772
Name:KLAIN, STANFORD
Entity Type:Individual
Prefix:MR
First Name:STANFORD
Middle Name:
Last Name:KLAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 W BAGLEY PARK RD BLDG J
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5697
Mailing Address - Country:US
Mailing Address - Phone:801-754-4155
Mailing Address - Fax:
Practice Address - Street 1:5500 W BAGLEY PARK RD BLDG J
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-5697
Practice Address - Country:US
Practice Address - Phone:801-754-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst