Provider Demographics
NPI:1245992429
Name:JOHNSON, ANNA LYNN (SAC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3397 HAYMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-8539
Mailing Address - Country:US
Mailing Address - Phone:715-892-5644
Mailing Address - Fax:
Practice Address - Street 1:3378 N. SCHILLEMAN ROAD
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-0189
Practice Address - Country:US
Practice Address - Phone:715-588-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19499-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)