Healthcare Provider Details

I. General information

NPI: 1417195538
Provider Name (Legal Business Name): ANNETTE JANELLE JOHNSON L.I.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11271 STATE ROUTE 762
ORIENT OH
43146-9005
US

IV. Provider business mailing address

1243 PAYNE LOOP
BLACKLICK OH
43004-8788
US

V. Phone/Fax

Practice location:
  • Phone: 614-214-3658
  • Fax:
Mailing address:
  • Phone: 614-214-3658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0800283
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: