Individual
SUSAN MARIE KLEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
182 SW ACADEMY ST, SUITE 304, DALLAS, OR 97338-1922
(503) 623-9289
Mailing address
182 SW ACADEMY ST, SUITE 304, DALLAS, OR 97338-1922
(503) 623-9289
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
04-R-19
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-R-19
CADC-II
OR
Enumeration date
05/01/2007
Last updated
07/08/2007
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