Provider Demographics
NPI:1003327123
Name:JOHNSON, PALMER W (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PALMER
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80932-0100
Mailing Address - Country:US
Mailing Address - Phone:719-635-9100
Mailing Address - Fax:719-442-1500
Practice Address - Street 1:2220 E BIJOU ST STE 160
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-8001
Practice Address - Country:US
Practice Address - Phone:719-635-9100
Practice Address - Fax:719-442-1500
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty