MEDICARE: KIMBERLY A JOHNSON LISW-S

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	I.1000241	OH

General Provider Information

NPI Number	:	1972648418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A JOHNSON LISW-S

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	CHILLICOTHEE
State	:	OH
Zip	:	45601-0188
Country	:	US
Telephone Number	:	740-773-4366
Fax Number	:	740-775-7855

Provider Business Practice Location Address
First Line	:	2434 RICHMILLER LN UNIT F
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-1075
Country	:	US
Telephone Number	:	740-423-8095
Fax Number	:	740-423-8096

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	11/05/2019

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