Provider Demographics
NPI:1386156958
Name:KLINGENBERG, LAURA BETH
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:KLINGENBERG
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 1:294 N FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4222
Mailing Address - Country:US
Mailing Address - Phone:513-896-3477
Mailing Address - Fax:
Practice Address - Street 1:294 N FAIR AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4222
Practice Address - Country:US
Practice Address - Phone:513-896-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.130691171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator