MEDICARE: DEANGELO JOHNSON SR.

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

General Provider Information

NPI Number	:	1750827051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANGELO JOHNSON SR.

Provider Business Mailing Address
First Line	:	3309 LEMUEL ST
Second Line	:
City	:	MUSKEGON HTS
State	:	MI
Zip	:	49444-2714
Country	:	US
Telephone Number	:	231-215-5047
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 LEMUEL ST
Second Line	:
City	:	MUSKEGON HTS
State	:	MI
Zip	:	49444-2714
Country	:	US
Telephone Number	:	231-215-5047
Fax Number	:

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

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	09/05/2025

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Directions to “ DEANGELO JOHNSON SR. ” Practice Location

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