Basic Information
| Provider Information | |||||||||
| NPI: | 1780092098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLENCK | ||||||||
| FirstName: | L. SUZANNE | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6249 CARLSON DR | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701222801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033610621 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 POYDRAS ST | ||||||||
| Address2: | SUITE 1950 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701303245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043223837 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 07/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1281 | LA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.