Provider Demographics
NPI:1376723247
Name:JOHNSON, DENISE M (LMSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 E 1600TH RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66006-8221
Mailing Address - Country:US
Mailing Address - Phone:785-248-9062
Mailing Address - Fax:785-242-6947
Practice Address - Street 1:1302 S MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3533
Practice Address - Country:US
Practice Address - Phone:785-242-8965
Practice Address - Fax:785-242-6947
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6826104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker