Healthcare Provider Details

I. General information

NPI: 1467022632
Provider Name (Legal Business Name): ASH JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ASH JOHNSON

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STEVENS ST SW
GRAND RAPIDS MI
49507-1526
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: