Healthcare Provider Details

I. General information

NPI: 1396317160
Provider Name (Legal Business Name): MEGAN JOHNSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date: 08/12/2021
Reactivation Date: 08/20/2021

III. Provider practice location address

701 W 41ST AVE STE 104
ANCHORAGE AK
99503-6604
US

IV. Provider business mailing address

22909 EAGLE RIVER RD
EAGLE RIVER AK
99577-9525
US

V. Phone/Fax

Practice location:
  • Phone: 907-782-4553
  • Fax: 907-563-0131
Mailing address:
  • Phone: 907-223-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSWS808
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2135655
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: