Provider Demographics
NPI:1457334435
Name:JOHNSON, AMANDA JUNE (LSCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JUNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JUNE
Other - Last Name:UNRUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:650 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-4030
Mailing Address - Country:US
Mailing Address - Phone:785-239-7000
Mailing Address - Fax:
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-239-7000
Practice Address - Fax:630-570-5779
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004889A1041C0700X
KS059851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical