Provider Demographics
NPI:1720141385
Name:JOHNSON, WES (LISW)
Entity Type:Individual
Prefix:
First Name:WES
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E BROAD ST 11TH FL
Mailing Address - Street 2:ATTN: TONYA FASONE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-466-9930
Mailing Address - Fax:614-644-9930
Practice Address - Street 1:2200 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223
Practice Address - Country:US
Practice Address - Phone:614-752-0333
Practice Address - Fax:614-752-0087
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker