Provider Demographics
NPI:1568718187
Name:CLEM, TONIA (MSW)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:CLEM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 S YUKON PKWY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4596
Mailing Address - Country:US
Mailing Address - Phone:405-265-0986
Mailing Address - Fax:405-265-0506
Practice Address - Street 1:373 S YUKON PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4596
Practice Address - Country:US
Practice Address - Phone:405-265-0986
Practice Address - Fax:405-265-0506
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical