Provider Demographics
NPI:1972903615
Name:JONSON, CLARENCE HUGH (ND)
Entity type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:HUGH
Last Name:JONSON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6818 GIBRALTER PLACE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221
Mailing Address - Country:US
Mailing Address - Phone:360-615-4722
Mailing Address - Fax:360-588-6081
Practice Address - Street 1:6818 GIBRALTER PLACE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221
Practice Address - Country:US
Practice Address - Phone:360-615-4722
Practice Address - Fax:360-588-6081
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND100202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist