Individual
JUDITH L. JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, CNS
Contact information
Practice address
523 W FLOATING FEATHER DRIVE, EAGLE, ID 83616
(208) 938-8588
Mailing address
523 W FLOATING FEATHER DRIVE, EAGLE, ID 83616
(208) 938-8588
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CNS18A, N10622
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025013
BLUE SHIELD
ID
05
—
8058014
—
ID
01
—
890000586
RAILROAD MEDICARE
ID
01
—
TBBV3
BLUE CROSS
ID
Enumeration date
10/03/2006
Last updated
05/16/2008
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