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General NPI Number Information
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NPI Number | 1598538209
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Entity Type | Individual
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Provider Name | ELIZABETH ANN JOHNSON LLMSW
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Gender | Female
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 1345 MONROE AVE NW STE 247
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4612
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Country | US
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Telephone | 616-255-9920
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Fax |
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Provider Business Mailing Address
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Address Line | 1942 R W BERENDS DR SW APT 3
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City | WYOMING
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State | MI
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Zip | 49519-6528
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Country | US
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Telephone | 616-255-9920
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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 | 6851117359
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License Number State | MI
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