Individual
MRS. CLARA DAWN TEDJAKESUMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AMFT
Contact information
Practice address
18 E MAIN ST STE 216, GREENFIELD, IN 46140-5541
(317) 649-4311
Mailing address
4737 EASTBROOK AVE, LAKEWOOD, CA 90713-2327
(562) 407-4181
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
IMF96958
CA
Other
Enumeration date
10/31/2018
Last updated
08/25/2021
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