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General NPI Number Information
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NPI Number | 1164505129
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Entity Type | Individual
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Provider Name | MISTI NICOLE-SMITH JOHNSON LISW
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 1201 63RD ST
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City | DES MOINES
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State | IA
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Zip | 50311-1943
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Country | US
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Telephone | 641-831-3261
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 S 3RD AVE E
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City | NEWTON
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State | IA
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Zip | 50208-4239
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Country | US
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Telephone | 641-792-8020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06466
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License Number State | IA
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