Provider Demographics
NPI:1497898423
Name:KLEIN, CYNTHIA JILL (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JILL
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4254 ELLIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3155
Mailing Address - Country:US
Mailing Address - Phone:651-307-3153
Mailing Address - Fax:
Practice Address - Street 1:4254 ELLIOT AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3155
Practice Address - Country:US
Practice Address - Phone:651-307-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN97251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical