Provider Demographics
NPI:1043236839
Name:JOHNSON, JANE ANNE (LSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 OREGONIA RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-3903
Mailing Address - Country:US
Mailing Address - Phone:513-695-2411
Mailing Address - Fax:513-695-2309
Practice Address - Street 1:50 GREENWOOD LN
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-3033
Practice Address - Country:US
Practice Address - Phone:937-746-1154
Practice Address - Fax:937-746-8523
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-169221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical