Provider Demographics
NPI:1518092493
Name:SHEILA L. KLEINMAN, PH.D., P.C.
Entity Type:Organization
Organization Name:SHEILA L. KLEINMAN, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:618-624-1210
Mailing Address - Street 1:822 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1808
Mailing Address - Country:US
Mailing Address - Phone:618-624-1210
Mailing Address - Fax:618-632-3136
Practice Address - Street 1:822 W STATE ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1808
Practice Address - Country:US
Practice Address - Phone:618-624-1210
Practice Address - Fax:618-632-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K02948Medicare ID - Type UnspecifiedIND. MEDICARE NUMBER
207971Medicare ID - Type UnspecifiedGROUP NUMBER
R00819Medicare UPIN