Healthcare Provider Details

I. General information

NPI: 1548068323
Provider Name (Legal Business Name): ERICA JOHNSON LLMSW, MED-EDL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 CONLON AVE SE
GRAND RAPIDS MI
49506-4932
US

IV. Provider business mailing address

1851 CONLON AVE SE
GRAND RAPIDS MI
49506-4932
US

V. Phone/Fax

Practice location:
  • Phone: 616-644-1374
  • Fax:
Mailing address:
  • Phone: 616-644-1374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: