1831582626 NPI number — MRS. JOELLE JOHNSON

Table of content: MRS. JOELLE JOHNSON (NPI 1831582626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831582626 NPI number — MRS. JOELLE JOHNSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JOELLE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831582626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 139
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59624-0139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-442-7920
Provider Business Mailing Address Fax Number:
406-442-7949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3240 DREDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59602-0548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-442-7920
Provider Business Practice Location Address Fax Number:
406-442-7949
Provider Enumeration Date:
03/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LAC-LAC-LIC-1068 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: SWP-LCSW-LIC-11613 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SWP-LCSW-LIC-11613 . This is a "STATE LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: LAC-LAC-LIC-1068 . This is a "STATE LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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