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NPI Code Detail

MEDICARE: PHILLIP JOHNSON LMSW

MEDICARE: PHILLIP JOHNSON LMSW
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 Worker6801059401MI

General Provider Information

NPI Number : 1790894970
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP JOHNSON LMSW
Provider Business Mailing Address
First Line : 610 S BURDICK ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49007-5221
Country : US
Telephone Number : 269-381-3700
Fax Number : 369-381-3810
Provider Business Practice Location Address
First Line : 610 S BURDICK ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49007-5221
Country : US
Telephone Number : 269-381-3700
Fax Number : 369-381-3810
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 04/25/2013

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Directions to “ PHILLIP JOHNSON LMSW” Practice Location

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