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Contact Information

ANDRA D. JOHNSON
4656 W JEFFERSON BLVD
SUITE 285
FORT WAYNE, IN46804-6857
 Phone: 260-422-9372
 Fax: 260-672-0859
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Addiction (Substance Use Disorder)

101YA0400X
Indicates primary specialty

NPI Profile & details for ANDRA D JOHNSON · (Female)

NPI # 1336468271
Status Active
Credentials
Entity Individual
Enumeration date 05/18/2010
Last updated 10/17/2011 - About 15 years ago
Sole proprietor 1 Not specified
Identifiers
  • IN License # 34005636A
  • IN License # 87000438A
  • OH License # 991842
  • OH License # I-0009358
  • WI License # 2972-123
  • WI Medicaid 39628200 (-31/078)
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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