Provider Demographics
NPI:1679195572
Name:PHILLIPSON, JOHNA J (LMSW)
Entity Type:Individual
Prefix:
First Name:JOHNA
Middle Name:J
Last Name:PHILLIPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10603 155TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTCH GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:52310-7447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 W 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1519
Practice Address - Country:US
Practice Address - Phone:319-975-1544
Practice Address - Fax:509-271-6151
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0978261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical