| Doctor Name: | DR. CYNTHIA ADELE KLUBNIK |
| NPI Number: | 1215239520 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 2203 |
| Business Practice Address: | 111 N 20th St Philomath, OR - 973709535 |
| Business Phone Number: | 5413684313 |
| Business Fax Number: | 5419294967 |
| Mailing Address: | Po Box 455, PHILOMATH |
| State: | OR |
| Postal Code: | 973700455 |
| Phone Number: | 5413684313 |
| Fax Number: | 5419294967 |
| NPI Enumeration Date: | 11/19/2010 |
| NPI Last Update Date: | 12/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TM1800X |
| License Number: | 2203 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Mental Retardation & Developmental Disabilities |
| Taxonomy Definition: | |