Organization
BREAKAWAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY CLEMETSON (DIRECTOR OF BILLING/CREDENTIALING)
(913) 475-7713
Entity
Organization
Contact information
Practice address
2023 SW GAGE BLVD, TOPEKA, KS 66604-3339
(785) 329-5344
(785) 329-5625
Mailing address
2021 VANESTA PL STE D, MANHATTAN, KS 66503-0381
(913) 475-7713
(913) 273-2994
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
12/12/2019
Last updated
12/12/2019
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