Doctor Name: | EMILY ROTH JOHNSON |
NPI Number: | 1316077860 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 3349125 |
Business Practice Address: | 500 Lake Steel Street Green Lake, WI - 54941 |
Business Phone Number: | 9202944070 |
Business Fax Number: | 9202944139 |
Mailing Address: | Po Box 588, GREEN LAKE |
State: | WI |
Postal Code: | 549410588 |
Phone Number: | 9202944070 |
Fax Number: | 9202944139 |
NPI Enumeration Date: | 03/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3349125 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |