Provider Demographics
NPI:1750748240
Name:KLATT, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:KLATT
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 1:15852 SWATHMORE CENTER CT
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1078
Mailing Address - Country:US
Mailing Address - Phone:734-751-0534
Mailing Address - Fax:
Practice Address - Street 1:15852 SWATHMORE CENTER CT
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1078
Practice Address - Country:US
Practice Address - Phone:734-751-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other