Provider Demographics
NPI:1427540707
Name:KLOCKE, ATHNASIA (MA)
Entity Type:Individual
Prefix:
First Name:ATHNASIA
Middle Name:
Last Name:KLOCKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NANCI
Other - Middle Name:
Other - Last Name:KLOCKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15694 DODGE MOWER RD
Mailing Address - Street 2:
Mailing Address - City:HAYFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55940-8438
Mailing Address - Country:US
Mailing Address - Phone:507-251-5008
Mailing Address - Fax:
Practice Address - Street 1:15694 DODGE MOWER RD
Practice Address - Street 2:
Practice Address - City:HAYFIELD
Practice Address - State:MN
Practice Address - Zip Code:55940-8438
Practice Address - Country:US
Practice Address - Phone:507-251-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health