Provider Demographics
NPI:1063643930
Name:JOHNSON, JENNIFER LEE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 LANDER AVE
Mailing Address - Street 2:
Mailing Address - City:HILMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95324-9398
Mailing Address - Country:US
Mailing Address - Phone:209-482-2952
Mailing Address - Fax:
Practice Address - Street 1:7807 LANDER AVE
Practice Address - Street 2:
Practice Address - City:HILMAR
Practice Address - State:CA
Practice Address - Zip Code:95324-9398
Practice Address - Country:US
Practice Address - Phone:209-482-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical