| Doctor Name: | KENNA M CLEMENTS |
| NPI Number: | 1588859672 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CACIII |
| License Number: | 6872 |
| Business Practice Address: | 350 Mckinley Street Walden, CO - 80480 |
| Business Phone Number: | 9707230055 |
| Business Fax Number: | 9707234732 |
| Mailing Address: | Po Box 40, GLENWOOD SPRINGS |
| State: | CO |
| Postal Code: | 816020040 |
| Phone Number: | 9709452241 |
| Fax Number: | 9709455523 |
| NPI Enumeration Date: | 09/11/2007 |
| NPI Last Update Date: | 08/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 6872 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |