Provider Demographics
NPI:1336372069
Name:JOHNSON, PAULINE J (RN; LMSW)
Entity type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN; LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SW CANTERBURY TOWN RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610-1501
Mailing Address - Country:US
Mailing Address - Phone:785-478-3603
Mailing Address - Fax:
Practice Address - Street 1:4015 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3412
Practice Address - Country:US
Practice Address - Phone:785-640-6855
Practice Address - Fax:785-354-9199
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7496104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker