Individual
LEROY JOHN KLASSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
SR 264 & HWY 191, GANADO, AZ 86505
(928) 755-4694
(928) 755-4747
Mailing address
PO BOX 176, GANADO, AZ 86505-0176
(928) 206-8231
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
UA2022082508
AZ
Other
Enumeration date
05/11/2023
Last updated
05/17/2023
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