Individual
JOHNNY ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M3754
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24989053
—
CO
05
—
69338558
—
NM
Enumeration date
10/26/2005
Last updated
05/20/2008
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