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Individual

MRS. JANETTA WILSON JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
114 ROUDY HOLLOW, SASSAFRAS, KY 41759-0308
(606) 642-4112
Mailing address
PO BOX 308, VICCO, KY 41773-0308
(606) 642-4112

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
07/10/2008
Last updated
07/10/2008
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