Provider Demographics
NPI:1275756454
Name:JOHNSON, BEVELYN JOYCE (MSW)
Entity Type:Individual
Prefix:
First Name:BEVELYN
Middle Name:JOYCE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-2746
Mailing Address - Country:US
Mailing Address - Phone:414-536-1301
Mailing Address - Fax:414-536-1568
Practice Address - Street 1:5401 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-2746
Practice Address - Country:US
Practice Address - Phone:414-536-1301
Practice Address - Fax:414-536-1568
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3754-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical