Individual
KELLY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
75 MDG, MENTAL HEALTH CLINIC, 7309 BALMER STREET, BLDG 545, HILL AFB, UT 84056
(801) 777-7909
Mailing address
325 MDG, 340 MAGNOLIA CIRCLE, TYNDALL AFB, FL 32403
(850) 283-7511
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089.0114986
VT
Other
Enumeration date
06/29/2015
Last updated
01/31/2019
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