Provider Demographics
NPI:1942622519
Name:KLING, JACQUELINE (LSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KLING
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:KLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:609 2ND AVE N
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-7449
Mailing Address - Country:US
Mailing Address - Phone:701-567-2967
Mailing Address - Fax:701-567-2498
Practice Address - Street 1:609 2ND AVE N
Practice Address - Street 2:
Practice Address - City:HETTINGER
Practice Address - State:ND
Practice Address - Zip Code:58639-7449
Practice Address - Country:US
Practice Address - Phone:701-567-2967
Practice Address - Fax:701-567-2498
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4072104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker