Provider Demographics
NPI:1700120508
Name:KLINKEBIEL, KAITLIN JANE
Entity Type:Individual
Prefix:MISS
First Name:KAITLIN
Middle Name:JANE
Last Name:KLINKEBIEL
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 1:500 LOUCKS WAY #16
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97327
Mailing Address - Country:US
Mailing Address - Phone:541-409-0717
Mailing Address - Fax:
Practice Address - Street 1:3415 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-234-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health