MEDICARE: CLARA L JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1063657542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA L JOHNSON

Provider Business Mailing Address
First Line	:	4500 SCOTT VALLEY RD
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027-9537
Country	:	US
Telephone Number	:	530-467-3956
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 SCOTT VALLEY RD
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027-9537
Country	:	US
Telephone Number	:	530-467-3956
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	12/11/2008

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Directions to “ CLARA L JOHNSON ” Practice Location

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