Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5767 | WI |
NPI | 1366078404 |
---|---|
Provider Name | Ms. Lauren C Johnson |
First Address | Milwaukee, WI 53222-5018 |
Second Address | Milwaukee, WI 53211-4508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2020 |
Last Update Date | 20/03/2020 |