MEDICARE: KELLY KLENE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	09926132	CO

General Provider Information

NPI Number	:	1790134682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY KLENE LCSW

Provider Business Mailing Address
First Line	:	916 S PECOS WAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-2605
Country	:	US
Telephone Number	:	720-515-0194
Fax Number	:	720-897-6934

Provider Business Practice Location Address
First Line	:	190 E 9TH AVE STE 290
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-2744
Country	:	US
Telephone Number	:	303-756-9052
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	06/12/2023

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