Provider Demographics
NPI:1558511972
Name:KLEMMENSEN, CATHLYN MARGOT
Entity Type:Individual
Prefix:MRS
First Name:CATHLYN
Middle Name:MARGOT
Last Name:KLEMMENSEN
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 1:6915 ROUNDROCK CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8233
Mailing Address - Country:US
Mailing Address - Phone:317-837-0404
Mailing Address - Fax:
Practice Address - Street 1:2345 S LYNHURST DR STE 107
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5100
Practice Address - Country:US
Practice Address - Phone:317-997-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health