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NPI Code Detail

MEDICARE: MS. LISA K JOHNSON LCSW

MEDICARE:  MS. LISA K JOHNSON  LCSW
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
11041C0700XClinical Social Worker2011041574MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12011041574OTHERMOLCSW

General Provider Information

NPI Number : 1588154280
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA K JOHNSON LCSW
Provider Business Mailing Address
First Line : 1430 OLIVE ST STE 400
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63103-2303
Country : US
Telephone Number : 314-362-3700
Fax Number :
Provider Business Practice Location Address
First Line : 6763 PAGE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1635
Country : US
Telephone Number : 314-206-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2018
Last Update Date : 05/17/2018

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Directions to “ MS. LISA K JOHNSON LCSW” Practice Location

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