Provider Demographics
NPI:1659516250
Name:JOHNSON, JENNIFER LYNN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 LUCERNE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6587
Mailing Address - Country:US
Mailing Address - Phone:440-239-5950
Mailing Address - Fax:440-239-7445
Practice Address - Street 1:7530 LUCERNE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-6587
Practice Address - Country:US
Practice Address - Phone:440-239-5950
Practice Address - Fax:440-239-7445
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10003791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI1000379OtherSTATE OF OHIO COUNSELOR, SOCIAL WORKER, MARRIAGE & FAMILY THERAPIST BOARD