Individual
BRENT CLEMENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
670 N 36TH ST, LAFAYETTE, IN 47905-4474
(765) 446-8412
Mailing address
917 KING ST, LAFAYETTE, IN 47905-1821
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005245A
IN
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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