Provider Demographics
NPI:1992712608
Name:JOHNSON, JEANNE E (LCSW)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:E
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 1:127 S. 37TH ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:402-476-9912
Practice Address - Street 1:127 S. 37TH ST.
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1502
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:402-476-9912
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE48118252626Medicaid
KS83049OtherBCBS
NE83049OtherBCBS
NE037118000OtherMAGELLAN
NE48118252626Medicaid