Provider Demographics
NPI:1346300126
Name:KLIEWER, CHERYL A
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:KLIEWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4149
Mailing Address - Country:US
Mailing Address - Phone:507-280-4107
Mailing Address - Fax:507-280-6010
Practice Address - Street 1:1700 N BROADWAY
Practice Address - Street 2:SUITE 154
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4199
Practice Address - Country:US
Practice Address - Phone:507-280-6054
Practice Address - Fax:507-280-6010
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN129331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN187930Medicare UPIN
MN57F92ABMedicare UPIN