Provider Demographics
NPI:1437525136
Name:KLAPWYK, TAMERA D
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:D
Last Name:KLAPWYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 EASTSIDE HWY
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-9696
Mailing Address - Country:US
Mailing Address - Phone:406-366-0855
Mailing Address - Fax:
Practice Address - Street 1:1967 N 1ST ST APT B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3198
Practice Address - Country:US
Practice Address - Phone:406-361-0110
Practice Address - Fax:406-573-1080
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12241101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1891781787Medicaid