Provider Demographics
NPI:1407049547
Name:KLITZKE, LINDA (LMFT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KLITZKE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 HEIGHTS DR
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4562
Mailing Address - Country:US
Mailing Address - Phone:715-832-8432
Mailing Address - Fax:715-832-5007
Practice Address - Street 1:2125 HEIGHTS DR
Practice Address - Street 2:SUITE 2D
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4562
Practice Address - Country:US
Practice Address - Phone:715-832-8432
Practice Address - Fax:715-832-5007
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI553-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39725500Medicaid