=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689345720
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AGGIE REBECCA-MARIA JOHNSON LLMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2021
-----------------------------------------------------
Last Update Date | 09/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7445 ALLEN RD STE 134
-----------------------------------------------------
City | ALLEN PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48101-1959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-405-9092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14616 STAHELIN AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48223-3604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-405-9092
-----------------------------------------------------
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 | 6801119091
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------