Provider Demographics
NPI:1790831790
Name:KLUGE, MARY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KLUGE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3726
Mailing Address - Country:US
Mailing Address - Phone:507-354-2443
Mailing Address - Fax:
Practice Address - Street 1:116 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2043
Practice Address - Country:US
Practice Address - Phone:507-931-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN53G09KLOtherBCBS INDIVIDUAL #
MNHP37548OtherHEALTH PARTNERS INDIV #
MN933761031561OtherPREFERRED ONE INDIV #
MN124996OtherUCARE INDIVIDUAL #