Individual provider Active NPI

Michelle Kloster

  • Clinical Psychologist
  • Bloomington, IN
National Provider Identifier
1528395951
Registry record updated Sep 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20042655A Issued in IN
Practice address
725 N Bell Trace Cir
Bloomington, IN 47408
Phone
(812) 323-2858
NPI assigned
Nov 5, 2009
Last updated
Sep 11, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X 20042655A IN Primary

Addresses

Primary practice location

725 N Bell Trace Cir
Bloomington, IN 47408

Mailing address

3210 E 10TH St Unit 5163
Bloomington, IN 47408-2753
Phone (562) 706-5175

Other practice location 1

9650 Zelzah Ave
Northridge, CA 91325-2003
Phone (818) 993-9311

Other practice location 2

4120 W Dresden Dr
Bloomington, IN 47404-8403
Phone (562) 706-5175

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1528395951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 E 10TH ST UNIT 5163",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474082753",
            "telephone_number": "562-706-5175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 N BELL TRACE CIR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47408",
            "telephone_number": "812-323-2858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9650 Zelzah Ave",
            "address_purpose": "LOCATION",
            "city": "Northridge",
            "state": "CA",
            "postal_code": "913252003",
            "country_code": "US",
            "telephone_number": "818-993-9311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4120 W Dresden Dr",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474048403",
            "country_code": "US",
            "telephone_number": "562-706-5175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLOSTER",
        "first_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-05",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042655A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.