MEDICARE: MS. BARBARA J JOHNSON MSW

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	987015	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	987015	OTHER	CO	LCSW

General Provider Information

NPI Number	:	1912036153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA J JOHNSON MSW

Provider Business Mailing Address
First Line	:	2975 BROADMOOR VALLEY RD
Second Line	:	STE. 103
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4466
Country	:	US
Telephone Number	:	719-576-1978
Fax Number	:	719-576-1979

Provider Business Practice Location Address
First Line	:	2975 BROADMOOR VALLEY RD
Second Line	:	STE. 103
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4466
Country	:	US
Telephone Number	:	719-576-1978
Fax Number	:	719-576-1979

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/10/2014

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