Provider Demographics
NPI:1376028597
Name:JOHNSON, ANDREW DUANE (MS CRIMINAL JUSTIC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DUANE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS CRIMINAL JUSTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 SPRING GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225-1821
Mailing Address - Country:US
Mailing Address - Phone:513-853-6930
Mailing Address - Fax:513-853-6934
Practice Address - Street 1:3129 SPRING GROVE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1821
Practice Address - Country:US
Practice Address - Phone:513-853-6930
Practice Address - Fax:513-853-6934
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110898171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator