Healthcare Provider Details

I. General information

NPI: 1740797844
Provider Name (Legal Business Name): CALLI LYNN JOHNSON LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7302 NORTHLAND DR
STANWOOD MI
49346-8742
US

IV. Provider business mailing address

PO BOX 338
STANWOOD MI
49346-0338
US

V. Phone/Fax

Practice location:
  • Phone: 231-823-4321
  • Fax:
Mailing address:
  • Phone: 231-250-0965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361007717
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361007717
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: