Provider Demographics
NPI:1568641355
Name:KING, LINDA JOHNSON
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JOHNSON
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 559
Mailing Address - Street 2:WRUSD NO 8 SPECIAL EDUCATION DEPARTMENT
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504
Mailing Address - Country:US
Mailing Address - Phone:928-729-6755
Mailing Address - Fax:928-729-7630
Practice Address - Street 1:NAVAJO ROUTE 12
Practice Address - Street 2:WINDOW ROCK UNIFIED SCHOOL DISTRICT 8
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-6754
Practice Address - Fax:928-729-7630
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ889446Medicare PIN