Provider Demographics
NPI:1598902249
Name:EIELSON, KENNETH G II (BS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:G
Last Name:EIELSON
Suffix:II
Gender:M
Credentials:BS
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Mailing Address - Street 1:2001 BLAKE AVE STE 1A
Mailing Address - Street 2:CHI/STORM KING CASE MANAGEMENT
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4269
Mailing Address - Country:US
Mailing Address - Phone:970-945-8669
Mailing Address - Fax:970-947-9158
Practice Address - Street 1:6916 HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-9435
Practice Address - Country:US
Practice Address - Phone:970-945-2241
Practice Address - Fax:970-945-5523
Is Sole Proprietor?:No
Enumeration Date:2009-01-17
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO6098101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6098OtherOLORADO DEPARTMENT OF REGULARTORY AGENCIES/CAC CERTIFICATION