Provider Demographics
NPI:1245938273
Name:JOHNSON, CANDI S
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 CHATTERTON ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-1804
Mailing Address - Country:US
Mailing Address - Phone:989-426-8886
Mailing Address - Fax:989-426-8889
Practice Address - Street 1:1302 CHATTERTON ST UNIT 2
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1804
Practice Address - Country:US
Practice Address - Phone:989-426-8886
Practice Address - Fax:989-426-8889
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator