MEDICARE: MRS. LIAT JOHNSON LISW-S

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	104100000X	Social Worker	I0010240	OH

General Provider Information

NPI Number	:	1487181616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIAT JOHNSON LISW-S

Provider Business Mailing Address
First Line	:	1655 TWIN OAKS DR
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-9511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 TILLER LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2267
Country	:	US
Telephone Number	:	614-783-1091
Fax Number	:

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

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	03/29/2019

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