Provider Demographics
NPI:1316798978
Name:KLETTKE, ELIZABETH ERIN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ERIN
Last Name:KLETTKE
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 1:1 HERMANN MUSEUM CIRCLE DR APT 3085
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7380
Mailing Address - Country:US
Mailing Address - Phone:863-327-3728
Mailing Address - Fax:
Practice Address - Street 1:1941 EAST RD STE 3236
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-6010
Practice Address - Country:US
Practice Address - Phone:713-486-2744
Practice Address - Fax:713-486-2553
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program