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General NPI Number Information
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NPI Number | 1447628078
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Entity Type | Individual
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Provider Name | CRYSTAL RENEE JOHNSON LISW
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Gender | Female
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 111 E VORIS ST
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City | AKRON
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State | OH
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Zip | 44311-1513
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Country | US
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Telephone | 216-219-3770
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Fax |
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Provider Business Mailing Address
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Address Line | 751 COITSVILLE RD
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City | CAMPBELL
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State | OH
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Zip | 44405-1148
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Country | US
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Telephone | 330-550-8175
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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 | S1451039
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I1700094
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License Number State | OH
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