Individual
JOHNNY BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1550 S 1000 E, CLEARFIELD, UT 84015-1646
(385) 456-6275
Mailing address
2053 S 800 E, CLEARFIELD, UT 84015-6244
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/24/2024
Last updated
01/24/2024
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