Healthcare Provider Details

I. General information

NPI: 1437706587
Provider Name (Legal Business Name): THERESE MARIE JOHNSON CEO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12460 LADD LN
AUBURN CA
95603-9571
US

IV. Provider business mailing address

12460 LADD LN
AUBURN CA
95603-9571
US

V. Phone/Fax

Practice location:
  • Phone: 530-305-8872
  • Fax: 530-466-3133
Mailing address:
  • Phone: 530-305-8872
  • Fax: 530-466-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberXXXXXXXXXXX
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberXXXXXXXXXXXX
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: