Provider Demographics
NPI:1639695000
Name:KLEEBERGER, ANNE MAY (LAC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MAY
Last Name:KLEEBERGER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2036
Mailing Address - Country:US
Mailing Address - Phone:612-203-1757
Mailing Address - Fax:
Practice Address - Street 1:4748 CHICAGO AVE STE 13
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-4311
Practice Address - Country:US
Practice Address - Phone:612-547-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1859171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist