Individual
DAVID ELDON CLEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
206 WALL ST, PORT JEFFERSON, OH 45360-1003
(937) 726-1566
Mailing address
PO BOX 202, PORT JEFFERSON, OH 45360-0202
(937) 726-1566
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S1501112
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S1501112
SOCIAL WORKER LICENCE
OH
Enumeration date
12/13/2017
Last updated
12/13/2017
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