Individual
MR. GARY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
406 TECHNOLOGY DR E, SUITE C, MENOMONIE, WI 54751-2767
(715) 235-4696
(715) 235-3941
Mailing address
E3364 COUNTY ROAD P, MENOMONIE, WI 54751-5303
(715) 235-9406
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
128438-121
WI
Other
Enumeration date
09/22/2014
Last updated
09/22/2014
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