Provider Demographics
NPI:1003309980
Name:JOHNSON, KATELYN D (LISW)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:D
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:4 BUCKEYE DR STE E302
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-9591
Practice Address - Country:US
Practice Address - Phone:740-753-6240
Practice Address - Fax:740-753-6241
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker