Individual
JAY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
16351 I94, HOME ON THE RANGE, SENTINEL BUTTE, ND 58654-9500
(701) 872-3745
(701) 872-3748
Mailing address
16351 I94, HOME ON THE RANGE, SENTINEL BUTTE, ND 58654-9500
(701) 872-3745
(701) 872-3748
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4012
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19170
—
ND
01
—
27570
BS OF ND
ND
Enumeration date
03/30/2007
Last updated
07/08/2007
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