Individual
DR. CYNTHIA ADELE KLUBNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
111 N 20TH ST, PHILOMATH, OR 97370-9535
(541) 368-4313
(541) 929-4967
Mailing address
PO BOX 455, PHILOMATH, OR 97370-0455
(541) 368-4313
(541) 929-4967
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-11-8303
TN
103TC2200X
Clinical Child & Adolescent Psychologist
2203
OR
103TM1800X
Intellectual & Developmental Disabilities Psychologist
2203
OR
103TS0200X
School Psychologist
Primary
2203
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103I682739
MEDICARE
—
Enumeration date
11/19/2010
Last updated
12/10/2012
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