Provider Demographics
NPI:1770079634
Name:KLEWENO, TALYN (LAT, ACT)
Entity type:Individual
Prefix:
First Name:TALYN
Middle Name:
Last Name:KLEWENO
Suffix:
Gender:F
Credentials:LAT, ACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1539
Mailing Address - Country:US
Mailing Address - Phone:785-259-8263
Mailing Address - Fax:
Practice Address - Street 1:3714 SUMMER LN
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1539
Practice Address - Country:US
Practice Address - Phone:785-259-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-015852255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer