Provider Demographics
NPI:1962507046
Name:KLINE, PATRICIA MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:KLINE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IA
Mailing Address - Zip Code:52342
Mailing Address - Country:US
Mailing Address - Phone:641-484-5234
Mailing Address - Fax:641-484-5632
Practice Address - Street 1:1309 S BROADWAY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IA
Practice Address - Zip Code:52342
Practice Address - Country:US
Practice Address - Phone:641-484-5234
Practice Address - Fax:641-484-5632
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00528104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01363Medicare ID - Type Unspecified