Individual
SIDNEY M JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PLPC
Contact information
Practice address
1221 BROADWAY ST, HANNIBAL, MO 63401
(573) 221-2111
Mailing address
1221 BROADWAY # ATH, HANNIBAL, MO 63401-4005
(573) 221-2111
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2017041669
MO
Other
Enumeration date
12/07/2017
Last updated
06/16/2018
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