Provider Demographics
NPI:1982673174
Name:KLUEMPER, JACQUELINE L (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:KLUEMPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPARTMENT 31
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-481-4000
Mailing Address - Fax:918-491-5740
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-481-4000
Practice Address - Fax:918-491-5740
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2090275OtherCIGNA BEHAVIORAL HEALTH
OK731308273 - 005OtherBLUE CROSS B SHIELD OF OK
2090275OtherCIGNA BEHAVIORAL HEALTH