Provider Demographics
NPI:1164676151
Name:JOHNSON, JENNIFER TWICHELL (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TWICHELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 S GARNER ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6326
Mailing Address - Country:US
Mailing Address - Phone:814-954-4939
Mailing Address - Fax:814-308-9073
Practice Address - Street 1:1315 S ALLEN ST STE 102
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5923
Practice Address - Country:US
Practice Address - Phone:814-308-9067
Practice Address - Fax:814-308-9073
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0160791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical