Provider Demographics
NPI:1437617610
Name:CLYMER, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CLYMER
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 1:1041 BIRKBECK ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:PA
Mailing Address - Zip Code:18224-1507
Mailing Address - Country:US
Mailing Address - Phone:570-956-3779
Mailing Address - Fax:
Practice Address - Street 1:1041 BIRKBECK ST
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:PA
Practice Address - Zip Code:18224-1507
Practice Address - Country:US
Practice Address - Phone:570-956-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program