Doctor Name: | JESSICA CHARMAINE JOHNSON |
NPI Number: | 1114322583 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 7321 Balmer Street, Bldg 570 75th Medical Group Hill Afb Hill Afb, UT - 84056 |
Business Phone Number: | 8017777909 |
Business Fax Number: | |
Mailing Address: | 4032 Princeton Dr, Apt A HILL AFB |
State: | UT |
Postal Code: | 84056 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/28/2014 |
NPI Last Update Date: | 10/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |