Provider Demographics
NPI:1629123930
Name:JOHNSON, MELINDA (LICSW, ACSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2003
Mailing Address - Country:US
Mailing Address - Phone:509-943-4241
Mailing Address - Fax:509-946-8519
Practice Address - Street 1:750 GEORGE WASHINGTON WAY
Practice Address - Street 2:SUITE #7
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4247
Practice Address - Country:US
Practice Address - Phone:509-946-1309
Practice Address - Fax:509-946-8519
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000053531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical