Provider Demographics
NPI:1245525971
Name:JOHNSON, MEGHANN ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:MEGHANN
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGHANN
Other - Middle Name:ELIZABETH
Other - Last Name:EDMUNDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:221 HILL STREET
Mailing Address - Street 2:PO BOX 1172
Mailing Address - City:OSBURN
Mailing Address - State:ID
Mailing Address - Zip Code:83849
Mailing Address - Country:US
Mailing Address - Phone:208-512-2522
Mailing Address - Fax:
Practice Address - Street 1:404 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2111
Practice Address - Country:US
Practice Address - Phone:208-783-0660
Practice Address - Fax:208-263-7515
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health