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General NPI Number Information
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NPI Number | 1366410102
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Entity Type | Individual
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Provider Name | LAURA D JOHNSTON LISW
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Gender | Female
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2500 JOHN GLENN HWY
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City | CAMBRIDGE
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State | OH
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Zip | 43725-9028
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Country | US
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Telephone | 740-454-9766
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Fax | 740-588-6452
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Provider Business Mailing Address
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Address Line | 177 LOWERY LN
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City | NEW CONCORD
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State | OH
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Zip | 43762-9795
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Country | US
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Telephone | 740-826-4376
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I8573
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License Number State | OH
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