Provider Demographics
NPI:1194970590
Name:JOHNSON, JANICE (LCSW)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 DANIELSON RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7252
Mailing Address - Country:US
Mailing Address - Phone:406-758-8100
Mailing Address - Fax:406-758-8150
Practice Address - Street 1:1605 DANIELSON RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7252
Practice Address - Country:US
Practice Address - Phone:406-758-8100
Practice Address - Fax:406-758-8150
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical