Healthcare Provider Details

I. General information

NPI: 1134176597
Provider Name (Legal Business Name): JEFFREY L KREMER MSE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 CASTLE CREEK RD
ASPEN CO
81611-3125
US

IV. Provider business mailing address

PO BOX 40
GLENWOOD SPRINGS CO
81602-0040
US

V. Phone/Fax

Practice location:
  • Phone: 970-920-5555
  • Fax: 970-920-5557
Mailing address:
  • Phone: 970-945-2241
  • Fax: 970-945-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number32
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: