Provider Demographics
NPI:1497390330
Name:JOHNSON, JOYCE R
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
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 254
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-0254
Mailing Address - Country:US
Mailing Address - Phone:801-796-2528
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 254
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-0254
Practice Address - Country:US
Practice Address - Phone:801-796-2528
Practice Address - Fax:385-225-9329
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099293801041C0700X
ID75716391041C0700X
UT11678892-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical