Provider Demographics
NPI:1588435085
Name:JOHNSTON, COURTNEY SUSAN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SUSAN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:SUSAN
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1045 CHARLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-1672
Mailing Address - Country:US
Mailing Address - Phone:937-602-6843
Mailing Address - Fax:
Practice Address - Street 1:1045 CHARLWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-1672
Practice Address - Country:US
Practice Address - Phone:937-602-6843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator