Provider Demographics
NPI:1023496387
Name:JOHNSON, KATRINA M (CTRS, MSW,LCSW)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CTRS, MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-0189
Mailing Address - Country:US
Mailing Address - Phone:608-638-7420
Mailing Address - Fax:608-638-7429
Practice Address - Street 1:210 AIRPORT ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665
Practice Address - Country:US
Practice Address - Phone:608-638-7420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8131-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical