Provider Demographics
NPI:1982912242
Name:JOHNSON, KATHRYN LYN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LYN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LYN
Other - Last Name:BREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3670 QUINCY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1993
Mailing Address - Country:US
Mailing Address - Phone:801-781-5733
Mailing Address - Fax:801-899-6634
Practice Address - Street 1:3670 QUINCY AVE STE 105
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1993
Practice Address - Country:US
Practice Address - Phone:801-781-5733
Practice Address - Fax:801-899-6634
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063901041C0700X
UT9709092-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN