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General NPI Number Information
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NPI Number | 1245118728
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Entity Type | Individual
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Provider Name | NIKKI K JOHANSEN
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Gender | Female
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Dates
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Enumeration Date | 08/23/2025
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Last Update Date | 08/23/2025
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Provider Practice Location Address
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Address Line | 955 W ALAMEDA RD
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City | POCATELLO
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State | ID
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Zip | 83201-6145
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Country | US
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Telephone | 208-237-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 331 N 400 W
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City | BLACKFOOT
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State | ID
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Zip | 83221-5472
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Country | US
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Telephone | 208-681-8283
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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