Provider Demographics
NPI:1851423131
Name:KLEIN, MARLENE SUE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:SUE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4761
Mailing Address - Country:US
Mailing Address - Phone:707-431-2528
Mailing Address - Fax:
Practice Address - Street 1:990 GROVE ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4761
Practice Address - Country:US
Practice Address - Phone:707-431-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2333171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist