Individual
MRS. JENNIFER LEIGH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2829 4TH AVE STE 150, LAKE CHARLES, LA 70601-7897
(337) 477-7091
Mailing address
7605 CHRIS LN, LAKE CHARLES, LA 70607-0747
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTZ561A78108
BLUE CROSS BLUE SHIELD
LA
Enumeration date
07/26/2013
Last updated
01/29/2019
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