Healthcare Provider Details

I. General information

NPI: 1427225507
Provider Name (Legal Business Name): ROBERT E JOHNSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4957 W FOND DU LAC AVE
MILWAUKEE WI
53216-2324
US

IV. Provider business mailing address

4957 W FOND DU LAC AVE
MILWAUKEE WI
53216-2324
US

V. Phone/Fax

Practice location:
  • Phone: 414-873-1960
  • Fax: 414-873-4990
Mailing address:
  • Phone: 414-873-1960
  • Fax: 414-873-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number571-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: