Provider Demographics
NPI:1689821415
Name:JOHNSON, JILL RENE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RENE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:RENE
Other - Last Name:HOEKSTRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:148 PARKDALE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-1128
Mailing Address - Country:US
Mailing Address - Phone:231-894-0052
Mailing Address - Fax:888-873-8402
Practice Address - Street 1:148 PARKDALE AVE STE D
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1128
Practice Address - Country:US
Practice Address - Phone:231-894-0052
Practice Address - Fax:888-873-8402
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010608881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical