Provider Demographics
NPI:1326916214
Name:KLAUCK, JOHN A JR (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KLAUCK
Suffix:JR
Gender:M
Credentials:DO
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 10200
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-6200
Mailing Address - Country:US
Mailing Address - Phone:505-992-5007
Mailing Address - Fax:
Practice Address - Street 1:21 TEN THOUSAND WAVES WAY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-8704
Practice Address - Country:US
Practice Address - Phone:505-982-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10073245101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral