Healthcare Provider Details

I. General information

NPI: 1427734425
Provider Name (Legal Business Name): EMILY ANNE JOHNSON LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 FULTON DR NW
CANTON OH
44718-2332
US

IV. Provider business mailing address

4522 FULTON DR NW
CANTON OH
44718-2332
US

V. Phone/Fax

Practice location:
  • Phone: 330-915-2907
  • Fax: 330-915-2958
Mailing address:
  • Phone: 330-915-2907
  • Fax: 330-915-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608476
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2309911
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: