Provider Demographics
NPI:1902358054
Name:KLETT, LAUREN KIMBERLY
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KIMBERLY
Last Name:KLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W SMITH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3683
Mailing Address - Country:US
Mailing Address - Phone:954-695-1967
Mailing Address - Fax:
Practice Address - Street 1:1010 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5926
Practice Address - Country:US
Practice Address - Phone:954-695-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRBT-16-16480247200000X
MI7401001569103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other