Provider Demographics
NPI:1447011705
Name:KLAUSMEIER, JEANETTE E (NLC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:E
Last Name:KLAUSMEIER
Suffix:
Gender:F
Credentials:NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 BLACK MAPLE LANE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921
Mailing Address - Country:US
Mailing Address - Phone:719-237-9662
Mailing Address - Fax:
Practice Address - Street 1:11760 BLACK MAPLE LANE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-8092
Practice Address - Country:US
Practice Address - Phone:719-237-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0110320103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist