Individual
JAY ROBERT CLEMENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
11660 ROUND LAKE BLVD NW, COON RAPIDS, MN 55433-2638
(763) 767-3350
Mailing address
11660 ROUND LAKE BLVD NW, COON RAPIDS, MN 55433-2638
(763) 528-5141
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304813
MN
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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