Provider Demographics
NPI:1013212000
Name:JOHNSON, BARBARA J (LISW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:ANDRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 W. CENTRAL PARK AVE
Mailing Address - Street 2:VERA FRENCH COMMUNITY MENTAL HEALTH CENTER
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804
Mailing Address - Country:US
Mailing Address - Phone:563-888-6275
Mailing Address - Fax:563-884-4638
Practice Address - Street 1:1441 W. CENTRAL PARK AVE
Practice Address - Street 2:VERA FRENCH COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804
Practice Address - Country:US
Practice Address - Phone:563-888-6275
Practice Address - Fax:563-884-4638
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA420716337Medicaid