Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1013100684 |
---|---|
Provider Name | Dr. Espen Klausen |
First Address | Fond Du Lac, WI 54935-4505 |
Second Address | Fond Du Lac, WI 54935-4505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 27/08/2007 |