1417479916 NPI number — AUBREY JANE KLOSTERMAN LMHC

Table of content: AUBREY JANE KLOSTERMAN LMHC (NPI 1417479916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417479916 NPI number — AUBREY JANE KLOSTERMAN LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLOSTERMAN
Provider First Name:
AUBREY
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
AUBREY
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
TLMHC, NCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417479916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1824 W 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR FALLS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50613-2056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-277-0992
Provider Business Mailing Address Fax Number:
319-277-5768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1824 W 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR FALLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50613-2056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-277-0992
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  087881 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)