Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 9472 | KS |
NPI | 1003207697 |
---|---|
Provider Name | Jovonna Johnson |
First Address | Wichita, KS 67202-4304 |
Second Address | Wichita, KS 67203-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2015 |
Last Update Date | 18/02/2015 |