Healthcare Provider Details

I. General information

NPI: 1245525971
Provider Name (Legal Business Name): MRS. MEGHANN ELIZABETH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGHANN ELIZABETH EDMUNDS L.M.S.W.

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MCKINLEY AVENUE
KELLOG ID
83837
US

IV. Provider business mailing address

221 HILL STREET PO BOX 1172
OSBURN ID
83849
US

V. Phone/Fax

Practice location:
  • Phone: 208-208-0115
  • Fax: 208-208-0115
Mailing address:
  • Phone: 208-512-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCSW-35318
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-35318
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: