Provider Demographics
NPI:1801966130
Name:JOHNSON, HEIDI ANN (MSED, LIMHP)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSED, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 W FAIDLEY AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4602
Mailing Address - Country:US
Mailing Address - Phone:308-382-4297
Mailing Address - Fax:308-754-4550
Practice Address - Street 1:2116 W FAIDLEY AVE STE 2100
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4602
Practice Address - Country:US
Practice Address - Phone:308-382-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE669101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health