Individual
SCOTT CLEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
905 N GURLEY AVE, GILLETTE, WY 82716-2109
(307) 686-0669
Mailing address
905 N GURLEY AVE, GILLETTE, WY 82716-2109
(307) 686-0669
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
020407A2
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3076860669
—
WY
Enumeration date
05/07/2015
Last updated
05/07/2015
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