MEDICARE: KATIE JOHNSON LISW

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	074946	IA

General Provider Information

NPI Number	:	1538688213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE JOHNSON LISW

Provider Business Mailing Address
First Line	:	700 16TH ST NE STE 205
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4665
Country	:	US
Telephone Number	:	319-382-4721
Fax Number	:	319-320-1211

Provider Business Practice Location Address
First Line	:	700 16TH ST NE STE 205
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4665
Country	:	US
Telephone Number	:	319-382-4721
Fax Number	:	319-320-1211

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

Provider Enumeration Date	:	09/14/2017
Last Update Date	:	07/21/2022

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Directions to “ KATIE JOHNSON LISW” Practice Location

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