Provider Demographics
NPI:1063847473
Name:JOHNSON, BREANNA JO (BA CADC)
Entity Type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BA CADC
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 1338
Mailing Address - Street 2:320 N EISENHOWER AVE
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1338
Mailing Address - Country:US
Mailing Address - Phone:641-424-2391
Mailing Address - Fax:641-424-0783
Practice Address - Street 1:320 N EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50402-1338
Practice Address - Country:US
Practice Address - Phone:641-424-2391
Practice Address - Fax:641-424-0783
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1077141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical