Provider Demographics
NPI:1417195538
Name:JOHNSON, ANNETTE JANELLE (LISW)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:JANELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 PAYNE LOOP
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8788
Mailing Address - Country:US
Mailing Address - Phone:614-214-3658
Mailing Address - Fax:
Practice Address - Street 1:11271 STATE ROUTE 762
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146-9005
Practice Address - Country:US
Practice Address - Phone:614-214-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.08002831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW34761Medicare PIN