Provider Demographics
NPI:1689395865
Name:KLEIN, JERROD ALAN
Entity Type:Individual
Prefix:
First Name:JERROD
Middle Name:ALAN
Last Name:KLEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21332 MORNING MIST WAY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-7625
Mailing Address - Country:US
Mailing Address - Phone:626-541-5547
Mailing Address - Fax:
Practice Address - Street 1:7340 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-5532
Practice Address - Country:US
Practice Address - Phone:727-367-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker