Provider Demographics
NPI:1760614358
Name:JOHNSON, LORI A (LMSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:JOHNSON
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 1:117 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3624
Mailing Address - Country:US
Mailing Address - Phone:906-360-7472
Mailing Address - Fax:906-273-1177
Practice Address - Street 1:102 W WASHINGTON ST STE 114
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4350
Practice Address - Country:US
Practice Address - Phone:906-360-7472
Practice Address - Fax:906-273-1177
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703053213164W00000X
MI68010914251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No164W00000XNursing Service ProvidersLicensed Practical Nurse