| NPI | 1689178113 |
|---|---|
| Former Name | JESSICA JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2020016207) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2017041039) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2020-07-09 |