Individual
KLARICE ANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
518 N STATE ST, SHELLEY, ID 83274-1113
(208) 557-1450
Mailing address
734 N HIGHWAY 91, FIRTH, ID 83236-1156
(208) 757-2932
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-36622
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881708832
—
ID
Enumeration date
06/23/2011
Last updated
02/26/2023
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