Provider Demographics
NPI:1700010550
Name:JOHNSTON, JENNIE LOUISE (LCSW, CDCS, MAC)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:LOUISE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW, CDCS, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 W WINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6319
Mailing Address - Country:US
Mailing Address - Phone:907-376-5255
Mailing Address - Fax:
Practice Address - Street 1:2925 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2983
Practice Address - Country:US
Practice Address - Phone:907-257-4847
Practice Address - Fax:907-257-6747
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical