Healthcare Provider Details

I. General information

NPI: 1306401468
Provider Name (Legal Business Name): KATHERINE JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE JONES BLAKNEY

II. Dates (important events)

Enumeration Date: 05/04/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W BENSON BLVD
ANCHORAGE AK
99503-3829
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-2500
  • Fax:
Mailing address:
  • Phone: 907-729-8961
  • Fax: 907-729-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number189749
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: