Provider Demographics
NPI:1801123096
Name:KLANKE, ROBERT HENRY (LLMSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HENRY
Last Name:KLANKE
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1976
Mailing Address - Country:US
Mailing Address - Phone:231-726-4735
Mailing Address - Fax:231-722-0789
Practice Address - Street 1:1095 3RD ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-1976
Practice Address - Country:US
Practice Address - Phone:231-726-4735
Practice Address - Fax:231-722-0789
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086367101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor