Individual
GLENYS S JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1935 MOTOR STREET, CLINICAL NUTRITION, DALLAS, TX 75235
(214) 456-2182
(214) 456-6287
Mailing address
1248 STEVENS RIDGE DRIVE, DALLAS, TX 75211
(214) 331-6043
(214) 456-6287
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
DT05235
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
847744
REGISTERED DIETITIAN
TX
01
—
DT05235
LICENSED DIETITIAN
TX
Enumeration date
10/04/2006
Last updated
07/09/2007
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