Provider Demographics
NPI:1326361130
Name:JOHNSON, LANA B (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:B
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10761 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:49099-9191
Mailing Address - Country:US
Mailing Address - Phone:574-400-5724
Mailing Address - Fax:574-293-0019
Practice Address - Street 1:10761 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WHITE PIGEON
Practice Address - State:MI
Practice Address - Zip Code:49099-9191
Practice Address - Country:US
Practice Address - Phone:574-400-5724
Practice Address - Fax:574-293-0019
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
IN33005821A104100000X
IN34006584A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker