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General NPI Number Information
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NPI Number | 1598902249
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Entity Type | Individual
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Provider Name | KENNETH G. EIELSON II BS
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Gender | Male
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Dates
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Enumeration Date | 01/17/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 6916 HIGHWAY 82
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-9435
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Country | US
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Telephone | 970-945-2241
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Fax | 970-945-5523
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Provider Business Mailing Address
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Address Line | 2001 BLAKE AVE STE 1A CHI/STORM KING CASE MANAGEMENT
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4269
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Country | US
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Telephone | 970-945-8669
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Fax | 970-947-9158
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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 | 6098
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License Number State | CO
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