Provider Demographics
NPI:1487643185
Name:JOHNSON, ESTHER (MS)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6571
Mailing Address - Country:US
Mailing Address - Phone:319-378-1199
Mailing Address - Fax:319-378-7497
Practice Address - Street 1:1221 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6571
Practice Address - Country:US
Practice Address - Phone:319-378-1199
Practice Address - Fax:319-378-7497
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA246427OtherMIDLANDS
IA29265OtherWELLMARK