Individual
BLAKE JEFFREY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
5400 KIRKWOOD BLVD SW, CEDAR RAPIDS, IA 52404-5216
(319) 364-0259
Mailing address
5400 KIRKWOOD BLVD SW, CEDAR RAPIDS, IA 52404-5216
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
096592
IA
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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