Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | S1700134 | OH |
NPI | 1003303645 |
---|---|
Provider Name | Donna Lavette Johnson |
First Address | Toledo, OH 43606-1169 |
Second Address | Toledo, OH 43606-1169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2018 |
Last Update Date | 19/04/2018 |