Provider Demographics
NPI:1215189964
Name:JOHNSON, DEBRA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
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 1:2020 E MILWAUKEE ST
Mailing Address - Street 2:#9
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2600
Mailing Address - Country:US
Mailing Address - Phone:608-752-4906
Mailing Address - Fax:
Practice Address - Street 1:2020 E MILWAUKEE ST
Practice Address - Street 2:#9
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-2600
Practice Address - Country:US
Practice Address - Phone:608-752-4906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72341231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical