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General NPI Number Information
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NPI Number | 1275197139
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Entity Type | Individual
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Provider Name | ELIZABETH JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 1205 S 70TH ST STE 301
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City | WEST ALLIS
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State | WI
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Zip | 53214
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Country | US
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Telephone | 414-475-2788
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Fax |
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Provider Business Mailing Address
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Address Line | W151N8649 MARSHALL DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3108
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Country | US
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Telephone | 262-364-8720
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 611-228
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1456
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License Number State | WI
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