Individual
MR. CLINTON GABRIEL JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1821 UNIVERSITY AVE W STE S137, SAINT PAUL, MN 55104-2891
(320) 339-6553
Mailing address
1821 UNIVERSITY AVE W STE S137, SAINT PAUL, MN 55104-2891
(320) 339-6553
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A486630300
—
MN
Enumeration date
09/28/2023
Last updated
09/28/2023
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