Provider Demographics
NPI:1639301740
Name:KLIBERT, JENNA M (MCD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:KLIBERT
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 TOLEDANO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4542
Mailing Address - Country:US
Mailing Address - Phone:504-897-2606
Mailing Address - Fax:504-891-6048
Practice Address - Street 1:1636 TOLEDANO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-4542
Practice Address - Country:US
Practice Address - Phone:504-897-2606
Practice Address - Fax:504-891-6048
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist