Provider Demographics
NPI:1639388127
Name:KLEPPERICH, JUDITH A (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:KLEPPERICH
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 PENN AVE S
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1325
Mailing Address - Country:US
Mailing Address - Phone:952-831-1303
Mailing Address - Fax:952-831-2114
Practice Address - Street 1:8100 PENN AVE S
Practice Address - Street 2:SUITE 105
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1325
Practice Address - Country:US
Practice Address - Phone:952-831-1303
Practice Address - Fax:952-831-2114
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT 248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0005430411OtherAETNA
MN113623OtherHEALTH PARTNERS
MN348M0KLOtherBLUE CROSS BLUE SHIELD
MN6256665OtherMEDICA