MEDICARE: MR. PERRY WILLIAM JOHNSTON MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	575-123	WI
2	103T00000X	Psychologist	435-124	WI
3	1041C0700X	Clinical Social Worker	575-123	WI
4	106H00000X	Marriage & Family Therapist	435-124	WI

General Provider Information

NPI Number	:	1154421550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PERRY WILLIAM JOHNSTON MSW

Provider Business Mailing Address
First Line	:	2600 NORTH MAYFAIR ROAD
Second Line	:	SUITE 850 PARKLAND CLINIC
City	:	MILWAUKEE
State	:	WI
Zip	:	53226
Country	:	US
Telephone Number	:	414-771-2088
Fax Number	:	414-771-6308

Provider Business Practice Location Address
First Line	:	2600 N MAYFAIR RD
Second Line	:	SUITE 850
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-1309
Country	:	US
Telephone Number	:	414-771-2088
Fax Number	:	414-771-6308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/23/2010

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