Provider Demographics
NPI:1902467723
Name:CLEMONS, JOSHUA STEPHEN (CPRS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:STEPHEN
Last Name:CLEMONS
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 MOUNT WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2026
Mailing Address - Country:US
Mailing Address - Phone:937-206-9336
Mailing Address - Fax:
Practice Address - Street 1:7502 MOUNT WHITNEY ST
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2026
Practice Address - Country:US
Practice Address - Phone:937-206-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001112175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist