Provider Demographics
NPI:1508309790
Name:JOHNSON, STEVEN (BSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 W WEIDMAN RD
Mailing Address - Street 2:
Mailing Address - City:WEIDMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48893-8786
Mailing Address - Country:US
Mailing Address - Phone:989-953-4357
Mailing Address - Fax:
Practice Address - Street 1:4273 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-5321
Practice Address - Country:US
Practice Address - Phone:989-953-4357
Practice Address - Fax:989-953-4358
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management