Individual
KATIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
973 CAMINO HERMOSA, CORRALES, NM 87048-8436
(505) 803-7459
Mailing address
612 COPPER AVE NE APT A, ALBUQUERQUE, NM 87102-3613
(651) 233-8965
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-11432
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30281555
—
NM
Enumeration date
11/09/2020
Last updated
10/20/2022
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