Provider Demographics
NPI:1801006622
Name:KLUETZ, SALLY L
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:L
Last Name:KLUETZ
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 1:3605 LAWNDALE LN N
Mailing Address - Street 2:UNIT 15
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-2927
Mailing Address - Country:US
Mailing Address - Phone:612-310-5435
Mailing Address - Fax:
Practice Address - Street 1:3605 LAWNDALE LN N
Practice Address - Street 2:UNIT 15
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-2927
Practice Address - Country:US
Practice Address - Phone:612-310-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist