Doctor Name: | JOHN CARL JOHNSON |
NPI Number: | 1093758658 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 1752-125 |
Business Practice Address: | 2066 Lawrence Dr De Pere, WI - 541159421 |
Business Phone Number: | 9203388699 |
Business Fax Number: | |
Mailing Address: | 2066 Lawrence Dr, DE PERE |
State: | WI |
Postal Code: | 541159421 |
Phone Number: | 9203388699 |
Fax Number: | |
NPI Enumeration Date: | 06/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 1752-125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |