Provider Demographics
NPI:1487253985
Name:MCNELIS-KLINE, CELINE MARIE
Entity type:Individual
Prefix:DR
First Name:CELINE
Middle Name:MARIE
Last Name:MCNELIS-KLINE
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 1:906 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4933
Mailing Address - Country:US
Mailing Address - Phone:715-432-4570
Mailing Address - Fax:
Practice Address - Street 1:455 E EISENHOWER PKWY STE 15
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3321
Practice Address - Country:US
Practice Address - Phone:734-219-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004305103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling