MEDICARE: HANNAH KRISTEN CLONINGER CPC-I, CADC-I, NCC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	08032-I	NV
2	101YP2500X	Professional Counselor	CI5572	NV

General Provider Information

NPI Number	:	1104700590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH KRISTEN CLONINGER CPC-I, CADC-I, NCC

Provider Business Mailing Address
First Line	:	2251 N RAMPART BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7640
Country	:	US
Telephone Number	:	702-305-6795
Fax Number	:

Provider Business Practice Location Address
First Line	:	2860 S BRONCO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5208
Country	:	US
Telephone Number	:	702-673-1489
Fax Number	:

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

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	07/31/2025

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