Provider Demographics
NPI:1396010831
Name:JOHNSON, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 BENTON DR
Mailing Address - Street 2:BLDG C SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5349
Mailing Address - Country:US
Mailing Address - Phone:530-242-2020
Mailing Address - Fax:530-241-4192
Practice Address - Street 1:2280 BENTON DR
Practice Address - Street 2:BLDG C SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-5349
Practice Address - Country:US
Practice Address - Phone:530-242-2020
Practice Address - Fax:530-241-4192
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker