Provider Demographics
NPI:1649313362
Name:JOHNSON, KRISTEN HEATHER (MSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:HEATHER
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:HEATHER
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:5651 FAIRVALE WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-5113
Mailing Address - Country:US
Mailing Address - Phone:530-218-2695
Mailing Address - Fax:
Practice Address - Street 1:5651 FAIRVALE WAY
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-5113
Practice Address - Country:US
Practice Address - Phone:530-218-2695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 198711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical