Individual
MR. CLARENCE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
1129 MORGAN ST., CLEVELAND, MS 38732
(662) 398-7575
Mailing address
1129 MORGAN ST., CLEVELAND, MS 38732
(662) 398-7575
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S0851
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112761
—
MS
Enumeration date
04/28/2008
Last updated
04/28/2008
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