Healthcare Provider Details

I. General information

NPI: 1578072476
Provider Name (Legal Business Name): RYAN JAMES JOHNSTON SSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N PAIUTE DR
CEDAR CITY UT
84721-6181
US

IV. Provider business mailing address

440 N PAIUTE DR
CEDAR CITY UT
84721-6181
US

V. Phone/Fax

Practice location:
  • Phone: 435-592-3234
  • Fax:
Mailing address:
  • Phone: 435-592-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8774105-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: