Provider Demographics
NPI:1922667401
Name:JOHNSON, RACHEL ANN (BSW)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW
Mailing Address - Street 1:300 SHELTON ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2312
Mailing Address - Country:US
Mailing Address - Phone:308-432-2747
Mailing Address - Fax:308-432-5092
Practice Address - Street 1:300 SHELTON ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2312
Practice Address - Country:US
Practice Address - Phone:308-432-2747
Practice Address - Fax:308-432-5092
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE17100000MXMedicaid