Individual
SUSAN D CLEMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD.
Contact information
Practice address
2013 N GREEN ACRES RD, SUITE C, FAYETTEVILLE, AR 72703
(479) 444-3354
(479) 555-6770
Mailing address
2013 N GREEN ACRES RD, SUITE C, FAYETTEVILLE, AR 72703
(479) 444-3354
(479) 555-6770
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
06-22P
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-5113370
TAX IDENTIFICATION NUMBER
IL
Enumeration date
03/13/2007
Last updated
04/28/2020
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