Individual
MR. CLARENCE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC III
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2598
(414) 454-6707
(414) 454-6747
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 647-6326
(414) 671-8860
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1876
WI
Other
Enumeration date
08/23/2006
Last updated
07/08/2007
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