Provider Demographics
NPI:1790782803
Name:KLEIN, JODI (LCSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 SAINT MATTHEWS AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3145
Mailing Address - Country:US
Mailing Address - Phone:502-897-8756
Mailing Address - Fax:502-897-3867
Practice Address - Street 1:161 SAINT MATTHEWS AVE STE 17
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3145
Practice Address - Country:US
Practice Address - Phone:502-897-8756
Practice Address - Fax:502-897-3867
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004523104100000X
KY12511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical