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1710003363
BRENT CLEMENZ
LAFAYETTE, IN
NPI
1710003363
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: IN 34005245A)
Enumeration Date
2007-03-22
Last Update Date
2007-07-08
Business Address
-- BRENT CLEMENZ
670 N 36TH ST
LAFAYETTE, IN 47905-4474
Phone number: 765-446-8412
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Mailing Address
-- BRENT CLEMENZ
917 KING ST
LAFAYETTE, IN 47905-1821
Phone number:
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