Healthcare Provider Details

I. General information

NPI: 1154486728
Provider Name (Legal Business Name): KATHRYN S JOHNSON LCSW CAC NCAC I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 SO COMMERCE DR STE 250
MURRAY UT
84107
US

IV. Provider business mailing address

5250 SO COMMERCE DR STE 250
MURRAY UT
84107
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-3500
  • Fax: 801-261-2111
Mailing address:
  • Phone: 801-261-3500
  • Fax: 801-261-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number34176
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: