Provider Demographics
NPI:1073378352
Name:JOHNSON, JAMES CORYE (LISW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CORYE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-1510
Mailing Address - Country:US
Mailing Address - Phone:319-830-1610
Mailing Address - Fax:
Practice Address - Street 1:116 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-1510
Practice Address - Country:US
Practice Address - Phone:319-830-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0723431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical