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General NPI Number Information
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NPI Number | 1588122253
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Entity Type | Individual
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Provider Name | CARISSA LYNN JOHNSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 2315 RUGER AVE
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City | JANESVILLE
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State | WI
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Zip | 53545-2603
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Country | US
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Telephone | 608-322-8756
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Fax |
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Provider Business Mailing Address
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Address Line | 2315 RUGER AVE
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City | JANESVILLE
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State | WI
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Zip | 53545-2603
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Country | US
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Telephone | 608-371-4392
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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 | 11058-C
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License Number State | NV
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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 | LC23245
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW126988
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2405982
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11307
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License Number State | WI
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