Provider Demographics
NPI:1902264328
Name:KLEM, TONYA (EDS)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:KLEM
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2724
Mailing Address - Country:US
Mailing Address - Phone:715-529-5374
Mailing Address - Fax:
Practice Address - Street 1:800 WILSON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2734
Practice Address - Country:US
Practice Address - Phone:715-256-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3001018297103TS0200X
WI900-58103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool