Provider Demographics
NPI:1215561683
Name:JOHNSON, RACHEL (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:465 E WINDY GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5542
Mailing Address - Country:US
Mailing Address - Phone:503-863-8281
Mailing Address - Fax:
Practice Address - Street 1:4190 S HIGHLAND DR STE 108
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2600
Practice Address - Country:US
Practice Address - Phone:385-367-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2023-10-11
Deactivation Date:2023-06-07
Deactivation Code:
Reactivation Date:2023-08-25
Provider Licenses
StateLicense IDTaxonomies
UT11256805-35021041C0700X
UT11256805-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical