Provider Demographics
NPI:1528650322
Name:KLEINTOP, JILLIAN
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:KLEINTOP
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 1:643 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-1458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:643 MAIN ST
Practice Address - Street 2:
Practice Address - City:SLATINGTON
Practice Address - State:PA
Practice Address - Zip Code:18080-1458
Practice Address - Country:US
Practice Address - Phone:484-623-9125
Practice Address - Fax:610-224-9305
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032622363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health