Individual
JENNIFER JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPSW
Contact information
Practice address
614 MCADOO ST STE B, T OR C, NM 87901-2706
(575) 297-0171
Mailing address
614 MCADOO ST STE B, T OR C, NM 87901-2706
(575) 297-0171
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1009
NM
Other
Enumeration date
12/17/2019
Last updated
02/19/2020
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