Healthcare Provider Details

I. General information

NPI: 1487565412
Provider Name (Legal Business Name): TIMOTHY LEED JOHNSON JR. CSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N 1950 W
SALT LAKE CITY UT
84116-3085
US

IV. Provider business mailing address

280 E BRIGHAM LN
NORTH SALT LAKE UT
84054-2321
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-8947
  • Fax:
Mailing address:
  • Phone: 210-305-3073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14291350-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: