Healthcare Provider Details

I. General information

NPI: 1568641355
Provider Name (Legal Business Name): MRS. LINDA JOHNSON KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LINDA JOHNSON

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAJO ROUTE 12 WINDOW ROCK UNIFIED SCHOOL DISTRICT 8
FORT DEFIANCE AZ
86504
US

IV. Provider business mailing address

PO BOX 559 WRUSD NO 8 SPECIAL EDUCATION DEPARTMENT
FORT DEFIANCE AZ
86504
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-6754
  • Fax: 928-729-7630
Mailing address:
  • Phone: 928-729-6755
  • Fax: 928-729-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: