Provider Demographics
NPI:1366938300
Name:KLECKER, SUSAN CATHERINE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CATHERINE
Last Name:KLECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 COTTAGE DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5962
Mailing Address - Country:US
Mailing Address - Phone:515-447-3002
Mailing Address - Fax:
Practice Address - Street 1:116 CHESTNUT ST E
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5116
Practice Address - Country:US
Practice Address - Phone:651-417-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist