MRS. JACQUELINE MARIE KLIETZ (NPI# 1538672043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538672043 |
| Entity Type | Individual |
| Full Name | MRS. JACQUELINE MARIE KLIETZ |
| Other Name | MISS JACQUELINE MARIE GRAY |
| Credential | LMFT |
| Practice Address |
5666 E State St Rockford IL 61108-2425 |
| Mailing Address |
2430 Barrington Pl Rockford IL 61107-1830 |
| Practice Telephone | 8154847053 |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2018-10-02 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
166.001072 | IL | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 692 Featherstone Rd, Rockford, IL 611076303 | 8154847053 |
| Street Address |
5666 E STATE ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61108-2425 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508849209 | Richard Emery Freeman | Neurological Surgery | 5666 E State St, Rockford, IL 61108-2425 | 2005-11-28 |
| 1881293348 | Salman Nafees | Nurse Anesthetist, Certified Registered | 5666 E State St, Rockford, IL 61108-2425 | 2020-10-25 |
| 1346856424 | Keely K Zunker | Nurse Practitioner | 5666 E State St, Rockford, IL 61108-2472 | 2020-09-23 |
| 1962026476 | Angie Youssef Hernandez | Student in an Organized Health Care Education/Training Program | 5666 E State St, Rockford, IL 61108-2425 | 2020-06-01 |
| 1568085710 | Kelsey Surowiec | Student in an Organized Health Care Education/Training Program | 5666 E State St, Rockford, IL 61108-2425 | 2020-05-22 |
| 1801415864 | Kyle R Clark | Physician Assistant | 5666 E State St, Rockford, IL 61108-2425 | 2020-04-10 |
| 1508495144 | Sadie Jae Pierce-mulligan | 5666 E State St, Rockford, IL 61108-2425 | 2020-04-06 | |
| 1376170183 | Nicole Ann O'neill | Dietitian, Registered | 5666 E State St, Rockford, IL 61108-2425 | 2020-03-24 |
| 1447884804 | Marissa Ann Giannangeli | Occupational Therapist | 5666 E State St, Rockford, IL 61108-2425 | 2020-02-25 |
| 1023659711 | Erin R. Moody | Physician Assistant | 5666 E State St, Rockford, IL 61108-2425 | 2019-10-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952862617 | Isr Enterprises, Inc. | Homemaker | 129 Phelps Ave, Bldg 10, Ste 1008, Rockford, IL 61108 | 2019-03-26 |
| 1003306465 | Adrienne Nicole Black | Behavior Technician | 519 Woodland Dr, Woodland Dr, Rockford, IL 61108 | 2018-05-11 |
| 1184085201 | Integrative Healing Center, LLC | Clinic/Center | 6019 Fincham Drive, Rockford, IL 61108 | 2016-03-17 |
| 1730547936 | Perryville Dentist PC | Dentist | 845 S Perryville Rd, Unit 119, Rockford, IL 61108 | 2016-02-02 |
| 1023489853 | Nicole Ping Ticknor | Counselor | 433 S. Phelps Ave., Suite 2, Rockford, IL 61108 | 2015-10-20 |
| 1275940348 | Northwest Home Care, Inc. | Home Health | 1437 S. Bell School Road, Suite 7, Rockford, IL 61108 | 2014-07-21 |
| 1487072922 | Alecia Greenlee | Psychiatry & Neurology | Rosecrance Community Mental Health, 3815 Harrison Avenue, Rockford, IL 61108 | 2014-04-02 |
| 1871925446 | Maria Laura Gustafson | Interpreter | 3208 Wesleyan Ave., Rockford, IL 61108 | 2013-08-06 |
| 1346582822 | Joseph Peevey | Pathology | 5666 E State Street, Department of Pathology, Rockford, IL 61108 | 2013-03-21 |
| 1134466923 | James Henry Peck | Hearing Instrument Specialist | 2424 Charles St, Rockford, IL 61108 | 2013-01-14 |
| Find all providers in zip 61108 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316571482 | Charles Theodore Strominger IIi | Counselor | 1003 N Prospect St, Rockford, IL 61107-3134 | 2020-02-27 |
| 1194366724 | Chelsie Ketton | Counselor | 2218 Custer Ave, Rockford, IL 61103-4374 | 2019-10-04 |
| 1467014282 | Ronald Charles Fleming Sr. | Counselor | 6408 Encantado Ct E, Rockford, MI 49341-9677 | 2019-07-01 |
| 1932685542 | Transformations Counseling Training and Consulting LLC | Counselor | 6066 Strathmoor Dr # C2, Rockford, IL 61107-6633 | 2018-07-17 |
| 1376045583 | Brittany Anne Bunton | Counselor | 5702 Elaine Dr. Suite 106, Rockford, IL 61108-2458 | 2018-03-03 |
| 1215435425 | Victor Hugo Mendoza | Counselor | 4623 Crescent Drive, Rockford, IL 61108-6110 | 2018-01-23 |
| 1639686538 | Lindsay M Lang Gluscic | Counselor | 915 Peter Ave, Rockford, IL 61108-3733 | 2018-01-02 |
| 1770975484 | Todd D Burd | Counselor | 6072 Brynwood Dr Ste 107a, Rockford, IL 61114-5829 | 2015-03-04 |
| 1083800601 | Lucille Anne Jenkins | Counselor | 2020 Glenview Rd, Rockford, IL 61107-1335 | 2007-09-18 |
| 1588790620 | Stephanie Anne Carey | Counselor | 5301 E State St Ste 302, Rockford, IL 61108-2399 | 2007-02-25 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.