Healthcare Provider Details

I. General information

NPI: 1285923417
Provider Name (Legal Business Name): CHRISTINE E JOHNSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE E BECKMAN

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/16/2024
Certification Date: 03/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 W 96TH ST
INDIANAPOLIS IN
46260-1191
US

IV. Provider business mailing address

702 W ALTO RD
KOKOMO IN
46902-4907
US

V. Phone/Fax

Practice location:
  • Phone: 317-876-3699
  • Fax: 574-537-2652
Mailing address:
  • Phone: 317-876-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: