MEDICARE: MICHELLE JOHNSON LISW

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	1041C0700X	Clinical Social Worker	I.2002495-SUPV	OH
2	104100000X	Social Worker	S1802842	OH

General Provider Information

NPI Number	:	1295215267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE JOHNSON LISW

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-9600
Fax Number	:	614-293-1456

Provider Business Practice Location Address
First Line	:	1800 ZOLLINGER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2849
Country	:	US
Telephone Number	:	614-293-9600
Fax Number	:	614-293-1456

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

Provider Enumeration Date	:	08/18/2018
Last Update Date	:	01/15/2026

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Directions to “ MICHELLE JOHNSON LISW” Practice Location

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