Provider Demographics
NPI:1306144084
Name:FLEMING, JOHANNE KAY
Entity type:Individual
Prefix:MS
First Name:JOHANNE
Middle Name:KAY
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JOHANNA
Other - Middle Name:KAY
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5965 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1720
Mailing Address - Country:US
Mailing Address - Phone:801-263-7100
Mailing Address - Fax:
Practice Address - Street 1:5965 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1720
Practice Address - Country:US
Practice Address - Phone:801-263-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT2003100005146M00000X
UT000383181001376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No376K00000XNursing Service Related ProvidersNurse's Aide