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General NPI Number Information
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NPI Number | 1235988643
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Entity Type | Individual
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Provider Name | DORIAN JOHNSON LSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 05/16/2024
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 10922 SCHUETZ RD
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City | SAINT LOUIS
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State | MO
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Zip | 63146-5704
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Country | US
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Telephone | 314-612-4827
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41
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City | FLORISSANT
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State | MO
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Zip | 63032-0041
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Country | US
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Telephone | 314-599-8323
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.112558
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License Number State | IL
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