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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

NPI # 1336468271
LBN Legal business name ANDRA D. JOHNSON
Authorized official ANDRA JOHNSON - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/18/2010
Last updated 10/17/2011 - About 15 years ago
Identifiers
IN License # 34005636A
IN License # 87000438A
OH License # 991842
OH License # I-0009358
WI License # 2972-123
WI Medicaid 39628200 (-31/078)
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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