Provider Demographics
NPI:1407473747
Name:BJERUM, JOANNA CHRISTINE (LSCSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:CHRISTINE
Last Name:BJERUM
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3025
Mailing Address - Country:US
Mailing Address - Phone:620-327-7404
Mailing Address - Fax:
Practice Address - Street 1:301 N MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3460
Practice Address - Country:US
Practice Address - Phone:620-327-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical