Healthcare Provider Details

I. General information

NPI: 1982912242
Provider Name (Legal Business Name): KATHRYN LYN JOHNSON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN LYN BREEN MSW

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 QUINCY AVE STE 105
OGDEN UT
84403-1993
US

IV. Provider business mailing address

670 12TH ST
OGDEN UT
84404-5877
US

V. Phone/Fax

Practice location:
  • Phone: 801-781-5733
  • Fax: 801-899-6634
Mailing address:
  • Phone: 801-781-5733
  • Fax: 801-899-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9709092-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006390
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: