MEDICARE: DR. KENNETH DUANE ALLRED PH.D.

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	103TC0700X	Clinical Psychologist	1533	CO

General Provider Information

NPI Number	:	1639252174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH DUANE ALLRED PH.D.

Provider Business Mailing Address
First Line	:	1115 ELKTON DRIVE
Second Line	:	SUITE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3597
Country	:	US
Telephone Number	:	719-590-6005
Fax Number	:	719-590-6030

Provider Business Practice Location Address
First Line	:	1115 ELKTON DR
Second Line	:	SUITE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8507
Country	:	US
Telephone Number	:	719-590-6005
Fax Number	:	719-590-6030

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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