Provider Demographics
NPI:1992367551
Name:JOHNSON, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N FOREST DR LOT 16
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-1924
Mailing Address - Country:US
Mailing Address - Phone:307-267-3703
Mailing Address - Fax:
Practice Address - Street 1:111 N FOREST DR LOT 16
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-1924
Practice Address - Country:US
Practice Address - Phone:307-267-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator