Provider Demographics
NPI:1710056288
Name:JOHNSON, LORNE ALLEN (PSYD)
Entity Type:Individual
Prefix:MR
First Name:LORNE
Middle Name:ALLEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616
Mailing Address - Country:US
Mailing Address - Phone:641-228-6830
Mailing Address - Fax:641-257-4395
Practice Address - Street 1:800 11TH STREET
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616
Practice Address - Country:US
Practice Address - Phone:641-228-6830
Practice Address - Fax:641-257-4395
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0101733Medicaid
R03173Medicare UPIN
IA0101733Medicaid