Provider Demographics
NPI:1912714460
Name:KLAYKO, ELLE B
Entity type:Individual
Prefix:
First Name:ELLE
Middle Name:B
Last Name:KLAYKO
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 1:12035 JERICHO DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9306
Mailing Address - Country:US
Mailing Address - Phone:412-482-7421
Mailing Address - Fax:
Practice Address - Street 1:28080 US HIGHWAY 98 STE F
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7012
Practice Address - Country:US
Practice Address - Phone:412-482-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty