Provider Demographics
NPI:1578614491
Name:JOHNSON, SHARRON LYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:SHARRON
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6904
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-6904
Mailing Address - Country:US
Mailing Address - Phone:719-686-1610
Mailing Address - Fax:719-687-1982
Practice Address - Street 1:602 W MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-1086
Practice Address - Country:US
Practice Address - Phone:719-686-1610
Practice Address - Fax:719-687-1982
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO101483Medicaid