Provider Demographics
NPI:1750865101
Name:JOHNSTON, LEANNA CHRISTINE
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:CHRISTINE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LEANNA
Other - Middle Name:C
Other - Last Name:BESSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2115 BURDETTE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2335
Mailing Address - Country:US
Mailing Address - Phone:402-344-7147
Mailing Address - Fax:
Practice Address - Street 1:2115 BURDETTE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-2335
Practice Address - Country:US
Practice Address - Phone:402-344-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13531041S0200X
NE36571041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool