Provider Demographics
NPI:1407051212
Name:KLOEHN, CORY (LCSW)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:KLOEHN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1844 SMOKEY CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8580
Mailing Address - Country:US
Mailing Address - Phone:919-917-4781
Mailing Address - Fax:
Practice Address - Street 1:14 TRI PARK WAY
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-6430
Practice Address - Country:US
Practice Address - Phone:920-831-0070
Practice Address - Fax:920-733-3822
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0061611041C0700X
WI127226104100000X
TX38120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker