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General NPI Number Information
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NPI Number | 1447813324
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Entity Type | Individual
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Provider Name | DONNIE FENNIMORE CAS
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Gender | Male
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 140 S PARKSIDE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3129
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Country | US
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Telephone | 719-358-7338
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Fax | 844-273-2340
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Provider Business Mailing Address
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Address Line | 140 S PARKSIDE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3129
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Country | US
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Telephone | 719-358-7338
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Fax | 844-273-2340
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CO
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