Provider Demographics
NPI:1023230026
Name:JOHNSON BARDSLEY, JILL ANN (MSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANN
Last Name:JOHNSON BARDSLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PEPIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4418
Mailing Address - Country:US
Mailing Address - Phone:603-748-6103
Mailing Address - Fax:603-225-5757
Practice Address - Street 1:12 PEPIN DRIVE
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-4418
Practice Address - Country:US
Practice Address - Phone:603-748-6103
Practice Address - Fax:603-225-5757
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1401372YONH01OtherANTHEMBLUECROSSBLUESHIEL
NH5950222OtherAETNA
NH1043905OtherCIGNA HEALTHCARE
NH30006754Medicaid
NH30006754Medicaid