MEDICARE: JORDIN BERNICE 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	101YS0200X	School Counselor		OH
2	1041C0700X	Clinical Social Worker	I.2405168	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316461056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDIN BERNICE JOHNSON LISW

Provider Business Mailing Address
First Line	:	3654 REVOLUTIONARY DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-6535
Country	:	US
Telephone Number	:	614-390-5091
Fax Number	:

Provider Business Practice Location Address
First Line	:	3654 REVOLUTIONARY DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-6535
Country	:	US
Telephone Number	:	614-390-5091
Fax Number	:

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

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	04/09/2024

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