Provider Demographics
NPI:1841824281
Name:JOHNSON, MICHAL LYNNE (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 W JORDAN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-6653
Mailing Address - Country:US
Mailing Address - Phone:801-651-9532
Mailing Address - Fax:
Practice Address - Street 1:9678 S 700 E STE 102
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3593
Practice Address - Country:US
Practice Address - Phone:801-576-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11417767-2504103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool