MEDICARE: DEBORAH A JOHANSON L.C.S.W.

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	3064	OR

General Provider Information

NPI Number	:	1447476833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH A JOHANSON L.C.S.W.

Provider Business Mailing Address
First Line	:	910 CAPITOL ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-1201
Country	:	US
Telephone Number	:	503-510-2887
Fax Number	:	503-540-7330

Provider Business Practice Location Address
First Line	:	910 CAPITOL ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-1201
Country	:	US
Telephone Number	:	503-510-2887
Fax Number	:	503-540-7330

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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