Individual
DENVER L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2900 SAINT ANTHONY DR, GREEN BAY, WI 54311-5859
(920) 391-6940
(920) 391-4811
Mailing address
2900 SAINT ANTHONY DR, GREEN BAY, WI 54311-5859
(920) 391-6940
(920) 391-4811
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1684
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39102700
—
WI
01
—
510142673019
BCBS
WI
Enumeration date
09/22/2006
Last updated
07/08/2007
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