Provider Demographics
NPI:1447813324
Name:FENNIMORE, DONNIE (CAS)
Entity type:Individual
Prefix:
First Name:DONNIE
Middle Name:
Last Name:FENNIMORE
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3129
Mailing Address - Country:US
Mailing Address - Phone:719-358-7338
Mailing Address - Fax:844-273-2340
Practice Address - Street 1:140 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3129
Practice Address - Country:US
Practice Address - Phone:719-358-7338
Practice Address - Fax:844-273-2340
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)