Provider Demographics
NPI:1477978336
Name:KLOSKY, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KLOSKY
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 1:1440 LAKESIDE AVE E
Mailing Address - Street 2:OFFICE OF PSYCHOLOGICAL SERVICES
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1137
Mailing Address - Country:US
Mailing Address - Phone:216-523-7984
Mailing Address - Fax:
Practice Address - Street 1:1440 LAKESIDE AVE E
Practice Address - Street 2:OFFICE OF PSYCHOLOGICAL SERVICES
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1137
Practice Address - Country:US
Practice Address - Phone:216-523-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH103TS0200XMedicaid