Provider Demographics
NPI:1457112989
Name:JOHNSON, STEPHANIE JORDAN (LLSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JORDAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LLSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11313 ROCKLAND
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2267
Mailing Address - Country:US
Mailing Address - Phone:248-986-3042
Mailing Address - Fax:
Practice Address - Street 1:29200 NORTHWESTERN HWY STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1055
Practice Address - Country:US
Practice Address - Phone:586-205-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical