Basic Information
| Provider Information | |||||||||
| NPI: | 1609160597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLINE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 FARAON ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645063512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162711066 | ||||||||
| FaxNumber: | 8162716786 | ||||||||
| Practice Location | |||||||||
| Address1: | 3608 FARAON ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645063044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162324417 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2011 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2010008567 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 1041C0700X | 2010008567 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.