Provider Demographics
NPI:1467190470
Name:JOHNSON, SHARON ANN (ATR)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W317S2951 ROBERTS CT N
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-9113
Mailing Address - Country:US
Mailing Address - Phone:171-534-0855
Mailing Address - Fax:
Practice Address - Street 1:524 MILWAUKEE ST STE 308
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1461
Practice Address - Country:US
Practice Address - Phone:715-340-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI142-36221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty