Provider Demographics
NPI:1205266335
Name:JOHNSON, CONSTANCE NEVLIN
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:NEVLIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3301 E FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-2225
Mailing Address - Country:US
Mailing Address - Phone:405-537-9333
Mailing Address - Fax:405-521-5580
Practice Address - Street 1:2500 S BROADWAY
Practice Address - Street 2:BLDG 100, SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4038
Practice Address - Country:US
Practice Address - Phone:405-216-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor