Provider Demographics
NPI:1962649269
Name:KLEIBER, JILL MARIE (LAC)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:MARIE
Last Name:KLEIBER
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 1:173 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2141
Mailing Address - Country:US
Mailing Address - Phone:860-503-3676
Mailing Address - Fax:860-503-3708
Practice Address - Street 1:173 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2141
Practice Address - Country:US
Practice Address - Phone:860-503-3676
Practice Address - Fax:860-503-3708
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003903-1171100000X
CT00440171100000X
CTCT000440171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist