Individual
THOMAS EDWARD KLECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW LP
Contact information
Practice address
1906 5TH AVE SE, LITTLE FALLS, MN 56345-0367
(320) 632-6647
(320) 632-9525
Mailing address
PO BOX 367, NORTHERN PINES MENTAL HEALTH CENTER, LITTLE FALLS, MN 56345-0367
(320) 632-6647
(320) 632-9525
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
1802
MN
1041C0700X
Clinical Social Worker
LICSW2045
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6268607
MEDICA
MN
01
—
69658KL
BLUE CROSS
MN
Enumeration date
11/27/2007
Last updated
11/27/2007
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