Provider Demographics
NPI:1356678874
Name:JOHNSON, JENNA RAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:RAE
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 1:4 HEARTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7322
Mailing Address - Country:US
Mailing Address - Phone:530-906-8124
Mailing Address - Fax:
Practice Address - Street 1:15 ILAHEE LN STE 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7205
Practice Address - Country:US
Practice Address - Phone:530-906-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical