Provider Demographics
NPI:1821006370
Name:KLEIN, ROGER J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-0364
Mailing Address - Country:US
Mailing Address - Phone:920-261-4100
Mailing Address - Fax:920-261-8801
Practice Address - Street 1:1315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094
Practice Address - Country:US
Practice Address - Phone:920-261-4100
Practice Address - Fax:920-261-8801
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1580057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1011094OtherPHYSICIANS PLUS INS
WI39101600Medicaid
WI39184249604OtherUNITY INSURANCE WATERTOWN
WI39184249605OtherUNITY INS LAKE MILLS
WI138422OtherMHN INSURANCE
6153731OtherUNITED BEHAVIORAL HEALTH
WI11259OtherDEAN CARE INS
39184249608OtherJOHN DEERE HEALTH
WI0000447050002Medicare ID - Type Unspecified