Provider Demographics
NPI:1376181859
Name:JOHNSON, LASONJA RENEE (MSW)
Entity Type:Individual
Prefix:MS
First Name:LASONJA
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LASONJA
Other - Middle Name:RENEE
Other - Last Name:LUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:8821 W DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-4867
Mailing Address - Country:US
Mailing Address - Phone:414-731-5059
Mailing Address - Fax:
Practice Address - Street 1:101 W BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4833
Practice Address - Country:US
Practice Address - Phone:414-731-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool