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NPI Code Detail

MEDICARE: JENNIFER ELLEN JOHNSON

MEDICARE: JENNIFER ELLEN 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
1101YA0400XAddiction (Substance Use Disorder) Counselor4420AK

General Provider Information

NPI Number : 1326693318
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ELLEN JOHNSON
Provider Business Mailing Address
First Line : PO BOX 871545
Second Line :
City : WASILLA
State : AK
Zip : 99687-1545
Country : US
Telephone Number : 907-376-4534
Fax Number : 907-376-2348
Provider Business Practice Location Address
First Line : 26731 W POINT MACKENZIE RD
Second Line :
City : WASILLA
State : AK
Zip : 99623-8709
Country : US
Telephone Number : 907-376-4534
Fax Number : 907-376-2348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2019
Last Update Date : 05/01/2026

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Directions to “ JENNIFER ELLEN JOHNSON ” Practice Location

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