Individual
MRS. JACQUELINE MARIE KLIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
5666 E STATE ST, ROCKFORD, IL 61108-2425
(815) 484-7053
Mailing address
2430 BARRINGTON PL, ROCKFORD, IL 61107-1830
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
166.001072
IL
Other
Enumeration date
11/07/2017
Last updated
10/02/2018
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