Provider Demographics
NPI:1154835049
Name:JOHNSON, RAILEE ANN (LMSW)
Entity type:Individual
Prefix:MS
First Name:RAILEE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3079 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2039
Mailing Address - Country:US
Mailing Address - Phone:734-972-3182
Mailing Address - Fax:
Practice Address - Street 1:117 N 1ST ST STE 106
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1354
Practice Address - Country:US
Practice Address - Phone:734-210-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011060861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical