Provider Demographics
NPI:1912422247
Name:KLOSTERMAN, CHERIE ANN
Entity Type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:ANN
Last Name:KLOSTERMAN
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 1:2411 PATHWAYS XING
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-5885
Mailing Address - Country:US
Mailing Address - Phone:618-355-4707
Mailing Address - Fax:618-355-4415
Practice Address - Street 1:BELLEVILLE AREA SPECIAL SERVICES COOPERATIVE
Practice Address - Street 2:2411 PATHWAYS CROSSING
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221
Practice Address - Country:US
Practice Address - Phone:618-355-4707
Practice Address - Fax:618-355-4415
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL204067103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool