MEDICARE: LYNN D. JOHNSON, PH.D., P.C.

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1457715450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNN D. JOHNSON, PH.D., P.C.

Provider Business Mailing Address
First Line	:	166 E 5900 S
Second Line	:	STE B-108
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-7257
Country	:	US
Telephone Number	:	801-261-1412
Fax Number	:	801-288-2269

Provider Business Practice Location Address
First Line	:	166 E 5900 S
Second Line	:	STE B-108
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-7257
Country	:	US
Telephone Number	:	801-261-1412
Fax Number	:	801-288-2269

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	LYNN D JOHNSON
Credential	:	PH.D.
Telephone Number	:	801-261-1412

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	04/06/2016

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