Healthcare Provider Details

I. General information

NPI: 1992712608
Provider Name (Legal Business Name): JEANNE E JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S. 37TH ST. SUITE A
LINCOLN NE
68510-1502
US

IV. Provider business mailing address

127 S. 37TH ST. SUITE A
LINCOLN NE
68510-1502
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-7557
  • Fax: 402-476-9912
Mailing address:
  • Phone:
  • Fax: 402-476-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number996
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: