Healthcare Provider Details

I. General information

NPI: 1942522982
Provider Name (Legal Business Name): ROBERT WAYNE JOHNSON MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S 900 W
CEDAR CITY UT
84720-3042
US

IV. Provider business mailing address

245 S 900 W
CEDAR CITY UT
84720-3042
US

V. Phone/Fax

Practice location:
  • Phone: 435-559-1756
  • Fax:
Mailing address:
  • Phone: 435-559-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number264437-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: