Individual
DR. SANDRA K JOHNSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
120 WYLDEWOOD DR, #B202, OSHKOSH, WI 54904-8631
(920) 479-8178
Mailing address
120 WYLDEWOOD DR, #B202, OSHKOSH, WI 54904-8631
(920) 479-8178
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15657-131
WI
101YP2500X
Professional Counselor
4407-125
WI
103T00000X
Psychologist
Primary
3184-57
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100015347
—
WI
Enumeration date
11/19/2010
Last updated
09/02/2014
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