Basic Information
| Provider Information | |||||||||
| NPI: | 1821258286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 W WELLS ST | ||||||||
| Address2: | SUITE 504 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532031866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142900444 | ||||||||
| FaxNumber: | 4142260351 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 W WELLS ST | ||||||||
| Address2: | SUITE 504 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532031866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142900444 | ||||||||
| FaxNumber: | 4142260351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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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 | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 3995-125 | 01 | WI | LICENSED PROFESSIONAL COUNSELOR | OTHER | 43733200 | 05 | WI | MEDICAID |