Provider Demographics
NPI:1922364520
Name:HARPER, JOHANNA (LISW)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 EDGEWOOD RD NW STE 203E
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-4472
Mailing Address - Country:US
Mailing Address - Phone:319-202-4687
Mailing Address - Fax:
Practice Address - Street 1:222 EDGEWOOD RD NW STE 203E
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-4472
Practice Address - Country:US
Practice Address - Phone:319-202-4687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IA0069561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0707669Medicaid