=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326526542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER DAWN JOHNSON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2018
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17019 N STATE HIGHWAY 5 STE C1
-----------------------------------------------------
City | SUNRISE BEACH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65079-7034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-692-2988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14893 HIGHWAY P
-----------------------------------------------------
City | GRAVOIS MILLS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65037-3915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-692-2988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2019035250
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------