Individual
MR. GARY BRIAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
4455 E 56TH ST, DAVENPORT, IA 52807
(563) 386-4004
(563) 386-4026
Mailing address
4455 E 56TH ST, DAVENPORT, IA 52807
(563) 386-4004
(563) 386-4026
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
00923
IA
Other
Enumeration date
04/23/2008
Last updated
04/23/2008
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