Provider Demographics
NPI:1548565617
Name:CLEMENTONI, PAMELA JANE (CMT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:CLEMENTONI
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5706
Mailing Address - Country:US
Mailing Address - Phone:970-769-9931
Mailing Address - Fax:
Practice Address - Street 1:408 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5706
Practice Address - Country:US
Practice Address - Phone:970-769-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10144172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker