Healthcare Provider Details

I. General information

NPI: 1285489443
Provider Name (Legal Business Name): SKYLA JOHNSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LAKE CLUB DR
COLUMBUS OH
43232-3204
US

IV. Provider business mailing address

701 TANGLEWOOD DR
FRIENDSWOOD TX
77546-2156
US

V. Phone/Fax

Practice location:
  • Phone: 614-704-5224
  • Fax:
Mailing address:
  • Phone: 419-283-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1802300
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: