Provider Demographics
NPI:1285803916
Name:JOHNSON, KRISTI M (MSW, CSW, BSW)
Entity type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, CSW, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E 100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1702
Mailing Address - Country:US
Mailing Address - Phone:801-428-3422
Mailing Address - Fax:801-322-4002
Practice Address - Street 1:340 E 100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1702
Practice Address - Country:US
Practice Address - Phone:801-428-3422
Practice Address - Fax:801-322-4002
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6411265-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical