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General NPI Number Information
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NPI Number | 1912138025
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Entity Type | Individual
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Provider Name | AMY SUSAN JOHNSON N.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 3018 DIXWELL AVE STE 3
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City | HAMDEN
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State | CT
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Zip | 06518-3508
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Country | US
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Telephone | 203-747-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 208 MOUNTAIN RD
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City | CHESHIRE
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State | CT
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Zip | 06410-2605
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Country | US
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Telephone | 203-525-6829
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 000390
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License Number State | CT
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