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General NPI Number Information
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NPI Number | 1235758087
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Entity Type | Individual
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Provider Name | KENDRA V JOHNSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/12/2020
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Last Update Date | 04/12/2020
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Provider Practice Location Address
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Address Line | 3520 WASHINGTON BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-3719
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Country | US
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Telephone | 317-343-8355
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 ILLINOIS RD
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City | FORT WAYNE
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State | IN
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Zip | 46804-1208
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Country | US
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Telephone | 866-710-7129
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Fax | 800-886-7248
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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 | 34008781A
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License Number State | IN
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