Provider Demographics
NPI:1821207986
Name:KLINGAMAN, SUSAN JEAN (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:KLINGAMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 39TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-3109
Mailing Address - Country:US
Mailing Address - Phone:309-738-9123
Mailing Address - Fax:
Practice Address - Street 1:1112 39TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-3109
Practice Address - Country:US
Practice Address - Phone:309-738-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1161321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker