Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 2901 | KY |
NPI | 1992978167 |
---|---|
Provider Name | Angela Diane Johnson |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 19/01/2021 |