Provider Demographics
NPI:1811266919
Name:BRIAN KLAUNG MSW INC
Entity type:Organization
Organization Name:BRIAN KLAUNG MSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KLAUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:815-398-7000
Mailing Address - Street 1:6975 REDANSA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1201
Mailing Address - Country:US
Mailing Address - Phone:815-398-7000
Mailing Address - Fax:
Practice Address - Street 1:6975 REDANSA DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1201
Practice Address - Country:US
Practice Address - Phone:815-398-7000
Practice Address - Fax:815-395-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL194-004675104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL568280Medicare UPIN