Jacqueline Marie Klietz, LMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

166.001072 Issued in IL

Practice address

5666 E State St
Rockford, IL 61108-2425

Phone

(815) 484-7053

NPI assigned

Nov 7, 2017

Last updated

Oct 2, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Jacqueline Marie Gray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1538672043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2430 BARRINGTON PL",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5666 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082425",
            "telephone_number": "815-484-7053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "692 Featherstone Rd",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611076303",
            "country_code": "US",
            "telephone_number": "815-484-7053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLIETZ",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-07",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "166.001072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "GRAY",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Angela Kitts-Faron, APN
• Brian Klaung, LCSW MSW
• Paul J Klazura, M.D.
• Brittany Klein, FNP-BC
• Amelia Johanna Klemp, M.S. CCC-SLP
• Christy Klikno
• Patrick James Klocek, D.O.
• Logan Klockner
• Sheila Lynn Klonicki
• Karl J. Klosowski, D.C.

• Mental Health Counselor in Rockford, IL
• Providers in Rockford, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.