Healthcare Provider Details

I. General information

NPI: 1740742949
Provider Name (Legal Business Name): KELSEY L CLEMENS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY L CHOW DO

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 GUNDERSEN DR
ONALASKA WI
54650-8447
US

IV. Provider business mailing address

1836 SOUTH AVE
LA CROSSE WI
54601-5429
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8100
  • Fax:
Mailing address:
  • Phone: 608-782-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71361
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: