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General NPI Number Information
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NPI Number | 1952847444
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Entity Type | Organization
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Legal Business Name | JANE L. JOHNSON, LLC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 2627 REDWING RD STE 235
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City | FORT COLLINS
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State | CO
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Zip | 80526-6352
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Country | US
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Telephone | 970-266-2678
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Fax | 970-631-8873
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Provider Business Mailing Address
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Address Line | 2627 REDWING RD STE 235
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City | FORT COLLINS
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State | CO
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Zip | 80526-6352
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Country | US
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Telephone | 970-266-2678
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Fax | 970-631-8873
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Authorized Official
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Title or Position | OWNER
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Name | JANE LOUISE JOHNSON
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Credential | LCSW
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Telephone | 970-266-2678
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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 | 989157
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License Number State | CO
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