Provider Demographics
NPI:1124774955
Name:JOHNSON, ALISON ROBIN (LPC-IT)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:ROBIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 QUENTIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-6634
Mailing Address - Country:US
Mailing Address - Phone:262-409-0191
Mailing Address - Fax:
Practice Address - Street 1:6405 QUENTIN ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-6634
Practice Address - Country:US
Practice Address - Phone:262-409-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5235226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor