Provider Demographics
NPI:1912138025
Name:JOHNSON, AMY SUSAN (ND)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUSAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2605
Mailing Address - Country:US
Mailing Address - Phone:203-525-6829
Mailing Address - Fax:
Practice Address - Street 1:3018 DIXWELL AVE STE 3
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3508
Practice Address - Country:US
Practice Address - Phone:203-747-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000390175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath