Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 4237-26 | WI |
NPI | 1326469198 |
---|---|
Provider Name | Ronald Klemp |
First Address | Hartford, WI 53027-1759 |
Second Address | Hartford, WI 53027-1759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2013 |
Last Update Date | 22/12/2013 |