Provider Demographics
NPI:1063657542
Name:JOHNSON, CLARA L
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SCOTT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:CA
Mailing Address - Zip Code:96027-9537
Mailing Address - Country:US
Mailing Address - Phone:530-467-3956
Mailing Address - Fax:
Practice Address - Street 1:4500 SCOTT VALLEY RD
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:CA
Practice Address - Zip Code:96027-9537
Practice Address - Country:US
Practice Address - Phone:530-467-3956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker