Individual
MRS. GLORIA JEAN JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5409 EVERYBODYS ROAD, FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER, CRANDON, WI 54520
(715) 478-4300
(715) 478-4490
Mailing address
PO BOX 396, 5409 EVERYBODYS ROAD FOREST COUNTY POTAWATOMI HEALTH, CRANDON, WI 54520
(715) 478-4300
(715) 478-4490
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6564123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
273386825009
BLUE CROSS BLUE SHIELD
WI
05
—
39752800
—
WI
01
—
69676
SECURITY HEALTH PLAN
WI
Enumeration date
08/04/2006
Last updated
07/08/2007
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