Provider Demographics
NPI:1043633142
Name:OLIVER-JOHNSON, TONYA L (MSW)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:L
Last Name:OLIVER-JOHNSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 BROADWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-2414
Mailing Address - Country:US
Mailing Address - Phone:219-882-4010
Mailing Address - Fax:219-882-0210
Practice Address - Street 1:839 BROADWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-2414
Practice Address - Country:US
Practice Address - Phone:219-882-4010
Practice Address - Fax:219-882-0210
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker