Provider Demographics
NPI:1639427719
Name:JOHNSON, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 N 16TH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5347
Mailing Address - Country:US
Mailing Address - Phone:602-248-9247
Mailing Address - Fax:602-224-8893
Practice Address - Street 1:4201 N 16TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5347
Practice Address - Country:US
Practice Address - Phone:602-248-9247
Practice Address - Fax:602-224-8893
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical