Provider Demographics
NPI:1255158119
Name:JOHNSON, LISA ASHELY (MSSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ASHELY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSSW
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 1211
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-1211
Mailing Address - Country:US
Mailing Address - Phone:970-430-6589
Mailing Address - Fax:
Practice Address - Street 1:3711 JOHN F KENNEDY PKWY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2620
Practice Address - Country:US
Practice Address - Phone:970-430-6589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.0000001836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker