Provider Demographics
NPI:1508031063
Name:KLEIN, CAROLYN (MS/CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467
Mailing Address - Country:US
Mailing Address - Phone:715-345-1425
Mailing Address - Fax:
Practice Address - Street 1:4880 RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467
Practice Address - Country:US
Practice Address - Phone:715-345-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI688-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist