Provider Demographics
NPI:1770607426
Name:JOHNSON, SUSAN DIANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4402
Mailing Address - Country:US
Mailing Address - Phone:307-463-0890
Mailing Address - Fax:307-463-0891
Practice Address - Street 1:103 N 5TH ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4402
Practice Address - Country:US
Practice Address - Phone:307-463-0890
Practice Address - Fax:307-463-0891
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-6891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical