Provider Demographics
NPI:1396556429
Name:KLUG, COURTNEY SUZANNE (LMSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SUZANNE
Last Name:KLUG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:SUZANNE
Other - Last Name:WADSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:226 W PINON DR
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4332
Mailing Address - Country:US
Mailing Address - Phone:262-661-1778
Mailing Address - Fax:
Practice Address - Street 1:226 W PINON DR
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4332
Practice Address - Country:US
Practice Address - Phone:262-661-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.115660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker