Provider Demographics
NPI:1922579655
Name:JOHNSON, NANCY G (LCSW SAC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 COUNTY RD. K
Mailing Address - Street 2:
Mailing Address - City:BLANCHARDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53516
Mailing Address - Country:US
Mailing Address - Phone:608-295-6432
Mailing Address - Fax:
Practice Address - Street 1:305 COUNTY RD. K
Practice Address - Street 2:
Practice Address - City:BLANCHARDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53516
Practice Address - Country:US
Practice Address - Phone:608-295-6432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7310-1231041C0700X
WI125-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)