Provider Demographics
NPI:1538688213
Name:JOHNSON, KATIE (LISW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:JOHNSON-LEFEBVRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:700 16TH ST NE STE 205
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4665
Mailing Address - Country:US
Mailing Address - Phone:319-382-4721
Mailing Address - Fax:319-320-1211
Practice Address - Street 1:700 16TH ST NE STE 205
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4665
Practice Address - Country:US
Practice Address - Phone:319-382-4721
Practice Address - Fax:319-320-1211
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0749461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical