Provider Demographics
NPI:1578041349
Name:KLEIN, KERRI T (LSW)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:T
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2291
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-2291
Mailing Address - Country:US
Mailing Address - Phone:701-577-0270
Mailing Address - Fax:701-577-0271
Practice Address - Street 1:1102 7TH AVE E
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4450
Practice Address - Country:US
Practice Address - Phone:701-572-7262
Practice Address - Fax:701-572-8783
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2346104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2346OtherND BOARD OF SOCIAL WORK EXAMINERS