Provider Demographics
NPI:1386019172
Name:KLEIN, LISA RAE (BS, MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RAE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RAE
Other - Last Name:KLOEHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, MS
Mailing Address - Street 1:150 STAHL RD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1231
Mailing Address - Country:US
Mailing Address - Phone:716-629-3465
Mailing Address - Fax:
Practice Address - Street 1:150 STAHL RD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1231
Practice Address - Country:US
Practice Address - Phone:716-629-3465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614716951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist