| NPI | 1063809218 |
|---|---|
| Former Name | JESSICA NICOLE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW111386) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2025-03-06 |