Provider Demographics
NPI:1417178617
Name:KLAVA, RHODA J (LSW)
Entity Type:Individual
Prefix:MS
First Name:RHODA
Middle Name:J
Last Name:KLAVA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 GREAT PLAINS CT
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-7248
Mailing Address - Country:US
Mailing Address - Phone:701-775-7725
Mailing Address - Fax:701-775-7880
Practice Address - Street 1:301 N 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3519
Practice Address - Country:US
Practice Address - Phone:701-775-7725
Practice Address - Fax:701-775-7880
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator