Individual
MRS. CLEANNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD,CD
Contact information
Practice address
520 N 4TH AVE, PASCO, WA 99301-5257
(509) 547-7704
(509) 542-3053
Mailing address
605 PRADERA CT, PASCO, WA 99301-4619
(509) 542-3052
(509) 542-3053
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI60470392
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DI60470392
DIETITIAN CERTIFICATION
WA
Enumeration date
09/11/2014
Last updated
09/11/2014
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