Provider Demographics
NPI:1407996234
Name:KLOCH, SUSAN (LICSW, LADC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KLOCH
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 8TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-1971
Mailing Address - Country:US
Mailing Address - Phone:308-324-7017
Mailing Address - Fax:866-578-3559
Practice Address - Street 1:1201 PARK ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1536
Practice Address - Country:US
Practice Address - Phone:308-324-7017
Practice Address - Fax:866-578-3559
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9861041C0700X
NE955101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)