Provider Demographics
NPI:1104030030
Name:JOHNSON, MARIA RUTHE (BSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:RUTHE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3052
Mailing Address - Country:US
Mailing Address - Phone:907-522-2290
Mailing Address - Fax:
Practice Address - Street 1:12840 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-3052
Practice Address - Country:US
Practice Address - Phone:907-522-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM6433Medicaid