=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801085717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANKYE E JOHNSON MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2007
-----------------------------------------------------
Last Update Date | 10/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 MONUMENT CIR SUITE 625
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46204-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-955-5080
-----------------------------------------------------
Fax | 317-955-5081
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6559 E 46TH ST
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46226-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-545-8618
-----------------------------------------------------
Fax | 317-221-2370
-----------------------------------------------------
=====================================================
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 | 34000480A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------