Provider Demographics
NPI:1376582890
Name:JOHNSON, JANE LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:LOUISE
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 1:2627 REDWING RD STE 235
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6352
Mailing Address - Country:US
Mailing Address - Phone:970-266-2678
Mailing Address - Fax:970-631-8873
Practice Address - Street 1:2627 REDWING RD STE 235
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6352
Practice Address - Country:US
Practice Address - Phone:970-266-2678
Practice Address - Fax:970-631-8873
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9891571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69785031Medicaid