Jaiden Klose
Individual provider Active NPI Psychologist · Lannon, WI
NPI 1295579456 · NPPES record last updated Jun 22, 2024
Key facts
- NPI
- 1295579456
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- Practice address
- 19216 Rock Pointe Way Unit 204Q
Lannon, WI 53046-1230 - Phone
- (918) 213-9877
- NPI assigned
- Jun 22, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Yes |
Addresses
Primary practice location
19216 Rock Pointe Way Unit 204Q
Lannon, WI 53046-1230
Mailing address
19216 Rock Pointe Way Unit 204Q
Lannon, WI 53046-1230
Phone (918) 213-9877
Other providers in Lannon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.