Provider Demographics
NPI:1699413872
Name:KLIMPEL, SHANNON SUE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:SUE
Last Name:KLIMPEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ROBERTS WAY
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1455
Mailing Address - Country:US
Mailing Address - Phone:160-774-2215
Mailing Address - Fax:
Practice Address - Street 1:310 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-1458
Practice Address - Country:US
Practice Address - Phone:160-773-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker