MEDICARE: MRS. ASHLEY DANELLE JOHNSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3726-C	AR
2	1041C0700X	Clinical Social Worker	2025039792	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5WW41	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1497992440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY DANELLE JOHNSON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 958539
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-8539
Country	:	US
Telephone Number	:	870-508-7610
Fax Number	:	870-508-7614

Provider Business Practice Location Address
First Line	:	624 HOSPITAL DR
Second Line	:	6 SOUTH
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2955
Country	:	US
Telephone Number	:	870-508-7820
Fax Number	:	870-508-7614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	05/15/2026

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