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NPI Code Detail

MEDICARE: MELISSA JOHNSON

MEDICARE: MELISSA JOHNSON
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
1103T00000XPsychologist10985147-2501UT

General Provider Information

NPI Number : 1194219709
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA JOHNSON
Provider Business Mailing Address
First Line : 265 E 100 S STE 250
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-1643
Country : US
Telephone Number : 304-376-0723
Fax Number :
Provider Business Practice Location Address
First Line : 265 E 100 S STE 250
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-1643
Country : US
Telephone Number : 801-483-2447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2018
Last Update Date : 03/29/2021

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Directions to “ MELISSA JOHNSON ” Practice Location

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