Provider Demographics
NPI:1265717599
Name:KLEINHENZ, SUSAN R
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:KLEINHENZ
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 1:2121 SAINT JAMES AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2601
Mailing Address - Country:US
Mailing Address - Phone:513-339-7027
Mailing Address - Fax:513-636-4283
Practice Address - Street 1:2142 ALPINE PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-3214
Practice Address - Country:US
Practice Address - Phone:513-399-7027
Practice Address - Fax:513-636-4283
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional