Provider Demographics
NPI:1710124474
Name:KLEIN, JAN MICHELE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:MICHELE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-6905
Mailing Address - Country:US
Mailing Address - Phone:914-907-7190
Mailing Address - Fax:
Practice Address - Street 1:48 SCOTLAND HILL RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-5837
Practice Address - Country:US
Practice Address - Phone:845-425-0887
Practice Address - Fax:845-425-2340
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009398-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist