Provider Demographics
NPI:1841005196
Name:JOHNSON, JENNIFER DAWN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
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 1:1700 E 38TH ST
Mailing Address - Street 2:CLC
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-4589
Mailing Address - Country:US
Mailing Address - Phone:765-674-3321
Mailing Address - Fax:
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:CLC
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4589
Practice Address - Country:US
Practice Address - Phone:765-674-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist